caa a22 4500 606220941 CHVBK 20210128101126.0 cr unu---uuuuu 210128e20150501xx s 000 0 eng 10.1007/s00380-014-0477-8 doi (NATIONALLICENCE)springer-10.1007/s00380-014-0477-8 Repeated occurrence of slow flow phenomenon during and late after sirolimus-eluting stent implantation [Elektronische Daten] [Kenji Sakata, Masanobu Namura, Toshimitsu Takagi, Naoto Tama, Isao Inoki, Hidenobu Terai, Yuki Horita, Masatoshi Ikeda, Masakazu Yamagishi] A 78-year-old man with unstable angina showed 90% stenosis in the proximal left anterior descending artery. Pre-procedural intravascular ultrasound revealed ruptured plaque and attenuated plaque in the lesion. Under these conditions, two overlapping sirolimus-eluting stent (SES) implantation in this lesion resulted in slow flow which was recovered by intracoronary nitrates, nicorandil, and nitroprusside without further complications. When the patient showed up again 5years later with recurrence of angina pectoris, angiography revealed a hazy ulcerated in-stent restenosis (ISR) at the site of the SES. Pre-procedural optical coherence tomography (OCT) imaging revealed multiple intimal ruptures, cavity formation behind the stent struts, a thin-cap fibroatheroma containing neointima surrounded by signal-poor, lipid-rich area in the proximal SES, suggesting the progression of neoatherosclerosis within SES. Importantly, there occurred slow flow again after balloon angioplasty for this lesion. We would suggest careful OCT examination is warranted to confirm development of neoatherosclerosis within the stent, and distal protection device should be considered to prevent slow flow phenomenon even in a patient with very late ISR. Springer Japan, 2014 Optical coherence tomography nationallicence Intravascular ultrasound nationallicence Percutaneous coronary intervention (PCI) nationallicence Slow flow phenomenon nationallicence Neoatherosclerosis nationallicence Sakata Kenji Division of Cardiovascular Medicine, Kanazawa University Graduate School of Medicine, 13-1 Takara-machi, 920-8640, Kanazawa, Ishikawa, Japan aut Namura Masanobu Division of Cardiology, Kanazawa Cardiovascular Hospital, Kanazawa, Japan aut Takagi Toshimitsu Division of Cardiology, Kanazawa Cardiovascular Hospital, Kanazawa, Japan aut Tama Naoto Division of Cardiology, Kanazawa Cardiovascular Hospital, Kanazawa, Japan aut Inoki Isao Division of Cardiology, Kanazawa Cardiovascular Hospital, Kanazawa, Japan aut Terai Hidenobu Division of Cardiology, Kanazawa Cardiovascular Hospital, Kanazawa, Japan aut Horita Yuki Division of Cardiology, Kanazawa Cardiovascular Hospital, Kanazawa, Japan aut Ikeda Masatoshi Division of Cardiology, Kanazawa Cardiovascular Hospital, Kanazawa, Japan aut Yamagishi Masakazu Division of Cardiovascular Medicine, Kanazawa University Graduate School of Medicine, 13-1 Takara-machi, 920-8640, Kanazawa, Ishikawa, Japan aut Heart and Vessels Springer Japan 30/3(2015-05-01), 406-409 0910-8327 30:3<406 2015 30 380 https://doi.org/10.1007/s00380-014-0477-8 text/html Onlinezugriff via DOI BK010053 XK010053 XK010000 Metadata rights reserved Springer special CC-BY-NC licence nationallicence 1 research-article jats NATIONALLICENCE NATIONALLICENCE NL-springer NATIONALLICENCE 856 40 https://doi.org/10.1007/s00380-014-0477-8 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Sakata Kenji Division of Cardiovascular Medicine, Kanazawa University Graduate School of Medicine, 13-1 Takara-machi, 920-8640, Kanazawa, Ishikawa, Japan aut NATIONALLICENCE 700 1- Namura Masanobu Division of Cardiology, Kanazawa Cardiovascular Hospital, Kanazawa, Japan aut NATIONALLICENCE 700 1- Takagi Toshimitsu Division of Cardiology, Kanazawa Cardiovascular Hospital, Kanazawa, Japan aut NATIONALLICENCE 700 1- Tama Naoto Division of Cardiology, Kanazawa Cardiovascular Hospital, Kanazawa, Japan aut NATIONALLICENCE 700 1- Inoki Isao Division of Cardiology, Kanazawa Cardiovascular Hospital, Kanazawa, Japan aut NATIONALLICENCE 700 1- Terai Hidenobu Division of Cardiology, Kanazawa Cardiovascular Hospital, Kanazawa, Japan aut NATIONALLICENCE 700 1- Horita Yuki Division of Cardiology, Kanazawa Cardiovascular Hospital, Kanazawa, Japan aut NATIONALLICENCE 700 1- Ikeda Masatoshi Division of Cardiology, Kanazawa Cardiovascular Hospital, Kanazawa, Japan aut NATIONALLICENCE 700 1- Yamagishi Masakazu Division of Cardiovascular Medicine, Kanazawa University Graduate School of Medicine, 13-1 Takara-machi, 920-8640, Kanazawa, Ishikawa, Japan aut NATIONALLICENCE 773 0- Heart and Vessels Springer Japan 30/3(2015-05-01), 406-409 0910-8327 30:3<406 2015 30 380