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Late Incomplete Stent Apposition following SES Using IVUS, OCT, and Angioscopy
- Operator: Sudhir Rathore, MD
Clinical Information

- Relevant clinical history and physical exam:
The patient was 39 years old male with risk factors of hypertension, hyperlipidemia and smoker. He presented with unstable angina. Clinical examination was normal.

- Relevant test results prior to catheterization:
ECG- Shows anterior changes.

- Relevant catheterization findings:
Cardiac Catheterization shows tight (99%) proximal stenosis in left anterior descending coronary artery with thrombus and TIMI 1 flow.(Fig. 1, Fig 2)

Interventional Management

Procedural step:
1. Thrombectomy was done followed by balloon dilatation and deployment of 3.5/33 Cypher (SES) stent in proximal LAD.
2. Post procedure coronary angiogram and IVUS shows good stent apposition. (Fig 3)
3. 18 months follow up coronary angiogram shows incomplete stent apposition and contrast staining outside the stent. (Fig 4)
4. 18 months IVUS shows stent malapposition and vessel dilatation.(Fig 5)
5. 18 months OCT shows stent incomplete apposition with fibrin on stent struts and mural thrombus. (Fig 6)
6. Angioscopy shows exposed stent struts, fibrin deposits on stent struts and red thrombus.( Movie 1)
7. This case shows late incomplete stent apposition and delayed arterial healing following SES.
8. We recommended long term dual antiplatelet therapy.

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