抄録
In the era of drug-eluting stents, in-stent restenosis remains a major concern in patients with coronary artery disease. Recently, in-stent restenotic tissue patterns on optical coherence tomography (OCT) have been reported. However, the characteristics of restenotic tissue in hemodialysis patients have not been fully investigated. In the present study, we observed eight in-stent restenotic lesions in eight hemodialysis patients who underwent percutaneous coronary intervention with coronary angioscopy (CAS) and OCT examination. Two lesions (one lesion with a bare metal stent and one lesion with an everolimus-eluting stent) showed a layered restenotic tissue on OCT and white or light yellow neointima on CAS. One lesion treated with a sirolimus-eluting stent showed a restenotic lesion with red mural thrombus on CAS and OCT. Other five lesions showed lipid-laden neointima on OCT, including two lesions with yellow neointima on CAS that were suggestive of lipid-rich neointima, and three lesions that were suggestive of neointimal calcification on CAS. We suggest the discrepancy between the angioscopic and OCT findings might be explained by the presence of neointimal calcifications containing lipidic components. Patients undergoing hemodialysis potentially have an increased risk of progressive calcified atherosclerosis. Our findings suggest rapid progression of neointimal calcification inside the stent might have occurred especially in hemodialysis status.
