Embolization of Neoatherosclerosis After Percutaneous Coronary Intervention

Introduction

An 85-year-old man was hospitalized because of ST-segment–elevation myocardial infarction 145 months after the implantation of sirolimus-eluting Cypher stent. Emergent coronary angiography identified in-stent restenosis at the body of sirolimus-eluting Cypher stent in the proximal right coronary artery (Figure [A]). Optical coherence tomography visualized rupture of lipidic neointima potentially containing cholesterol crystals (Figure [B]). Near-infrared spectroscopy (NIRS) combined with intravascular ultrasound showed extensive yellow signals indicating lipid accumulation, potentially both within and outside the stent, with a high, maximum 4-mm lipid core burden index with 880 (Figure [C] and [D]). After an implantation of cobalt–chromium everolimus-eluting stent, no-reflow phenomenon with thrombolysis in …