Abstract
We report a case of excessive axial plaque redistribution leading to luminal narrowing at the reference segment confirmed by serial intravascular ultrasound during coronary stent implantation.
Minimal longitudinal redistribution of plaque from the lesion into the reference segment is known to occur during stent implantation . We report a case of excessive axial plaque redistribution leading to luminal narrowing at the reference segment confirmed by intravascular ultrasound (IVUS). A 62-year-old man with chronic heart failure due to dilated cardiomyopathy was admitted to our institution with the diagnosis of posterior silent myocardial ischaemia documented by stress scintigraphy. Baseline angiography showed a critical stenosis in the proximal portion of the left circumflex artery ( Fig. 1 A ). Pre-interventional IVUS revealed an eccentric positive remodelled lesion without calcification ( Fig. 1 b and c). The proximal reference segment at the level of an atrial circumflex branch (⁎) was normal ( Fig. 1 a). Subsequently, a 3.5×24-mm stent was implanted after balloon predilatation. Angiography showed minimal intraluminal filling defect at the proximal reference segment alongside the stent ( Fig. 2 A ). IVUS revealed modest protrusion of the plaque from the 2 to 5 o’clock position ( Fig. 2 a). After postdilatation with a 4.5×12-mm noncompliant balloon, angiography showed deterioration of the filling defect ( Fig. 2 B). IVUS demonstrated a significant increase of the plaque area ( Fig. 2 b) next to the stent proximal edge ( Fig. 2 b, arrow). Another 3.5×9-mm stent was implanted to cover the new luminal narrowing due to the axial plaque shift. Final angiography and IVUS showed good results ( Fig. 3 ).
