Revista Española de Cardiología (English Edition) Revista Española de Cardiología (English Edition)
Rev Esp Cardiol. 2018;71:291 - Vol. 71 Num.04 DOI: 10.1016/j.rec.2017.07.002

In Vivo Pathologic Confirmation of Neoatherosclerosis

Pilar Jiménez-Quevedo a,, Nieves Gonzalo a, Fernando Alfonso b

a Departamento de Cardiología, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
b Departamento de Cardiología, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria, IIS-IP, Universidad Autónoma de Madrid, Madrid, Spain

Article

Previous pathological reports have described in-stent neoatherosclerosis as a new underlying pathological substrate to late thrombotic events. A 63-year-old man, who had undergone implantation of a drug-eluting stent in the midright coronary artery 2 years previously, presented with an inferior ST-segment elevation myocardial infarction. Emergent coronary angiography revealed stent thrombosis at the right coronary artery (Figure 1, arrow). Thromboaspiration retrieved abundant material and obtained a normal anterograde coronary flow (Figure 1). Subsequently, the artery was treated with balloon angioplasty with a good angiographic result (Figure 1). Optical coherence tomography (Figure 2) was performed immediately after thromboaspiration and disclosed the presence of neoatherosclerosis, consisting of a large lipid areas (+) obscuring most of the underlying stent struts and a large cap rupture (Figure 2). A glistening neointima covering the lipid pools (+) and a plaque cavity (arrow) originating from the adjacent ruptured cap was also observed (Figure 2). A white thrombus (T) is readily depicted in the lumen (Figure 2); (*) denotes wire artifact. There was also mild neointimal proliferation at the edge of the stent (Figure 2). Intracoronary specimens obtained after aspiration were examined histopathologically with Masson's trichrome staining (Figure 3; 20 x). The retrieved tissue at higher magnification (Figure 3: 40 x) consisted of thrombus (T), cholesterol crystals (arrows), lipid-laden, foamy, macrophages (arrowheads) and a large necrotic core (NC), the hallmark of in-stent neoatherosclerosis.

Figure 1.

Figure 2.

Figure 3.

This case illustrates in vivo the close correlation between intracoronary imaging and the corresponding pathological substrate in a patient with in-stent neoatherosclerosis complicated by atherosclerotic plaque rupture leading to very late stent thrombosis.

Corresponding author: patrop@telefonica.net

1885-5857/© 2018 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved

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