The Korean Journal of Medicine

The Korean Association of Internal Medicine (대한내과학회)
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A Case of Neointimal Calcification in a Drug-Eluting Stent

약물 용출성 스텐트에서 발견된 신생내막 석회화 1예

  • Yang, Young-June (Department of Internal Medicine, Yonsei University College of Medicine) ;
  • Shim, Jae-Min (Department of Internal Medicine, Yonsei University College of Medicine) ;
  • Kim, Jung-Sun (Department of Internal Medicine, Yonsei University College of Medicine) ;
  • Ko, Young-Guk (Department of Internal Medicine, Yonsei University College of Medicine) ;
  • Choi, Dong-Hoon (Department of Internal Medicine, Yonsei University College of Medicine) ;
  • Jang, Yang-Soo (Department of Internal Medicine, Yonsei University College of Medicine) ;
  • Hong, Myeong-Ki (Department of Internal Medicine, Yonsei University College of Medicine)
  • 양영준 (연세대학교 의과대학 내과학교실) ;
  • 심재민 (연세대학교 의과대학 내과학교실) ;
  • 김중선 (연세대학교 의과대학 내과학교실) ;
  • 고영국 (연세대학교 의과대학 내과학교실) ;
  • 최동훈 (연세대학교 의과대학 내과학교실) ;
  • 장양수 (연세대학교 의과대학 내과학교실) ;
  • 홍명기 (연세대학교 의과대학 내과학교실)
  • Published : 2011.07.01
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Abstract

Neointimal hyperplasia is the main mechanism of stent restenosis. Therefore, drug-eluting stents have replaced bare metal stents because there is less neointima and scar formation. Recently, some cases of stent restenosis after using a bare metal stent were found to involve calcification, not neointimal hyperplasia, and regarded as de novo atherosclerosis. We report unusual circular calcification inside a drug-eluting stent, which we called neointimal calcification.

본 증례는 ST 분절 상승의 심근경색으로 약물 용출성 스텐트를 삽입한 환자에서 4년 후 발견된 스텐트 내강 안쪽을 둘러싼 원형의 두꺼운 석회침착소견에 대하여 신생내막과 관련된 새로운 죽상동맥경화증으로 추정하여 보고하는 바이다.

Keywords

References

  1. Colombo A, Drzewiecki J, Banning A, et al. Randomized study to assess the effectiveness of slow-and moderate-release polymer-based paclitaxel-eluting stents for coronary artery lesions. Circulation 2003;108:788-794. https://doi.org/10.1161/01.CIR.0000086926.62288.A6
  2. Stone GW, Ellis SG, Cox DA, et al. A polymer-based, paclitaxeleluting stent in patients with coronary artery disease. N Engl J Med 2004;350:221-231. https://doi.org/10.1056/NEJMoa032441
  3. Morice MC, Serruys PW, Sousa JE, et al. A randomized comparison of a sirolimus-eluting stent with a standard stent for coronary revascularization. N Engl J Med 2002;346:1773-1780. https://doi.org/10.1056/NEJMoa012843
  4. Moses JW, Leon MB, Popma JJ, et al. Sirolimus-eluting stents versus standard stents in patients with stenosis in a native coronary artery. N Engl J Med 2003;349:1315-1323. https://doi.org/10.1056/NEJMoa035071
  5. Wexler L, Brundage B, Crouse J, et al. Coronary artery calcification: pathophysiology, epidemiology, imaging methods, and clinical implications:a statement for health professionals from the American Heart Association: Wrighting Group. Circulation 1996;94:1175-1192. https://doi.org/10.1161/01.CIR.94.5.1175
  6. McGeachie M, Ramoni RL, Mychaleckyi JC, et al. Integrative predictive model of coronary artery calcification in atherosclerosis. Circulation 2009;120:2448-2454. https://doi.org/10.1161/CIRCULATIONAHA.109.865501
  7. Mautner SL, Mautner GC, Froehlich J, et al. Coronary artery disease: prediction with in vitro electron beam CT. Radiology 1994;192:625-630.
  8. Rumberger JA, Simons DB, Fitzpatrick LA, Sheedy PF, Schwartz RS. Coronary artery calcium area by electron-beam computed tomography and coronary: atherosclerotic plaque area: a histopathologic correlative study. Circulation 1995;92:2157-2162. https://doi.org/10.1161/01.CIR.92.8.2157
  9. Sangiorgi G, Rumberger JA, Severson A, et al. Arterial calcification and not lumen stenosis is highly correlated with atherosclerotic plaque burden in humans: a histologic study of 723 coronary artery segments using nondecalcifying methodology. J Am Coll Cardiol 1998;31:126-133.
  10. Fischman DL, Leon MB, Baim DS, et al. A randomized comparison of coronary stent placement and balloon angioplasty in the treatment of coronary artery disease: Stent Restenosis Study Investigatiors. N Engl J Med 1994;331:496-501. https://doi.org/10.1056/NEJM199408253310802
  11. Hoffman R, Mintz GS, Dussaillant GR, et al. Patterns and mechanisms of in-stent restenosis: a serial intravascular ultrasound study. Circulation 1996;94:1247-1254. https://doi.org/10.1161/01.CIR.94.6.1247
  12. Mehran R, Dangas G, Abizaid AS, et al. Angiographic patterns of in-stent restenosis: classification and implications for long-term outcome. Circulation 1999;100:1872-1878. https://doi.org/10.1161/01.CIR.100.18.1872
  13. Kastrati A, Hall S, Schomig A. Long-term outcome after coronary stenting. Curr Control Trials Cardiovasc Med 2000;1:48-54. https://doi.org/10.1186/CVM-1-1-048
  14. Doyle B, Rihal CS, O'Sullivan CJ, et al. Outcomes of stent thrombosis and restenosis during extended follow-up of patients treated with bare-metal coronary stents. Circulation 2007;116:2391-2398. https://doi.org/10.1161/CIRCULATIONAHA.107.707331
  15. Agostoni P, Vermeersch P, Knaapen M, Verheye S. Stent thrombosis is not always stent thrombosis: de novo atherosclerosis in a stented coronary segment. Int J Cardiol 2010;144:e19-21. https://doi.org/10.1016/j.ijcard.2008.12.078
  16. Fineschi M, Carrera A, Gori T. Atheromatous degeneration of the neointima in a bare metal stent: intravascular ultrasound evidence. J Cardiovasc Med (Hagerstown) 2009;10:572-573. https://doi.org/10.2459/JCM.0b013e32832bca4e
  17. Appleby CE. A calcified neointima: "Stent" within a stent. J Invasive Cardiol 2009;21:141-143.