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In-Stent Neointimal Hyperplasia With 16-Row Multislice Computed Tomography Coronary Angiography

Originally publishedhttps://doi.org/10.1161/01.CIR.0000147830.07781.8BCirculation. 2004;110:e514

    A 55-year-old woman was admitted to Erasmus Medical Center with unstable angina pectoris. She had no risk factors for coronary disease. The ECG taken on admission showed ST depression in leads I, II, aVL, aVF, and V2 through V6. Serial troponin T and cardiac enzyme measurements were normal. Multislice computed tomography (MSCT) coronary angiography performed with a 16-row MSCT scanner showed a high-grade stenosis of the left main coronary artery with no other significant lesions (Figure 1A through 1C; Data Supplement Movie I). Conventional angiography was performed on the same day and confirmed the diagnosis. Immediate percutaneous intervention was undertaken, and a bare-metal stent (diameter, 5.0 mm; length, 18 mm) was implanted successfully from the left main into the left anterior descending coronary artery, with an excellent final angiographic result.

    Figure 1. Volume-rendered (A, B) and multiplanar reconstruction (C) images show high-grade stenosis of the left main coronary artery (arrows), which subsequently was confirmed by conventional angiography (D, arrows). A cross-sectional image of the lesion (inset) shows calcified (CA) and noncalcified (NC) plaque tissue components surrounding the lumen (☆).

    Follow-up MSCT coronary angiography 4 months later showed moderate neointimal hyperplasia within the stent (Figure 2A and 2B; Data Supplement Movie II), which was confirmed by conventional angiography (Figure 2C and 2D). MSCT coronary angiography is a useful clinical tool for diagnosis and in-stent neointimal hyperplasia assessment of left main coronary artery disease.

    Figure 2. Volume-rendered image (A) and corresponding conventional angiography image (D) after 4 months’ follow-up. B, Moderate neointimal hyperplasia (ih) presenting as a dark rim surrounding the lumen (L), located at the distal part of the stent (S), which subsequently was confirmed by conventional angiography (D, arrowheads).

    The online-only Data Supplement, which contains Movies I and II, is available with this article at http://www.circulationaha.org.

    Footnotes

    Correspondence to Nico R. Mollet, MD, Erasmus Medical Center, Department of Cardiology and Radiology, Thoraxcenter, Bd 410, PO Box 2040, 3000 CA Rotterdam, The Netherlands. E-mail