Author + information
- Tsubasa Sakamoto, MD,
- Tomonori Itoh, MD∗ (, )
- Yudai Shimoda, MD,
- Tetsuya Fusazaki, MD and
- Yoshihiro Morino, MD
- ↵∗Division of Cardiology, Department of Internal Medicine, Memorial Heart Center, Iwate Medical University, 19-1, Uchimaru, Morioka-City, Iwate 020-8505, Japan
The drug-eluting balloon (DEB) is a device that is used to reduce the risk of repeat stent implantation in patients with in-stent restenosis (ISR) (1). Characterization of tissue by optical coherence tomography (OCT) may provide useful information to identify good candidates for DEBs (2). However, the image visualized by OCT just after DEB dilation is unclear. We present images after DEB dilation visualized by OCT.
A 45-year-old man was treated with a bare metal stent (BMS) (S-stent 4.0/23.0 mm) implanted in the right coronary artery (RCA) for acute ST-segment elevation myocardial infarction. After percutaneous coronary intervention (PCI), he was taking 100 mg of aspirin and 75 mg of clopidogrel. However, a second coronary angiography at 6 months after BMS implantation showed ISR in the BMS. A repeat PCI was performed for ISR in the RCA. After the guide wire was advanced to the distal portion of the RCA, the target lesion was dilated using a 4.0/13.0 mm scoring balloon catheter (Lacrosse nonslip element [NSE] balloon, Goodman Company, Ltd., Nagoya, Japan). After NSE dilation, the target lesion was dilated using a 4.0/20.0 mm DEB system (SeQuent Please, B. Braun, Melsungen, Germany and NIPRO Corporation, Osaka, Japan). OCT was performed to evaluate ISR before (Figure 1A), just after NSE dilation (Figure 1B), and DEB (Figure 1C). OCT catheter was used with a Dragonfly JP image catheter (St. Jude Medical, Westford, Massachusetts). OCT demonstrated high-intensity superficial regions of the intimal tissue with intensity attenuation (not stent strut) after DEB dilation (Figures 1D to 1I).
The high-intensity superficial regions are thought to represent an iopromide/paclitaxel mixture because SeQuent Please uses the contrast medium iopromide to separate and evenly distribute paclitaxel molecules over the surface of the balloon.
After the PCI procedure, we assessed whether the contrast media could be visualized by OCT in an in vitro setting using the same system. We performed OCT on a surgical grove that was wet with contrast medium iomeprol, with a glove with dried contrast medium on the surface, and a glove without contrast medium.
We confirmed similar high-intensity superficial regions due to dry contrast medium smeared on the surgical glove visualized by OCT. However, we could not visualize high-intensity superficial regions with wet contrast medium or without contrast media.
Further studies are required to determine whether these areas do indeed represent iopromide and/or paclitaxel because we do not know with certainty the composition of the high-intensity regions.
- American College of Cardiology Foundation