Authors: Mody Rohit, Dash Debabrata, Mody Bhavya, Saholi Aditya, Khullar Akshit.
Rationale: Drug-eluting stents (DES) have been demonstrated to successfully reduce the rate of instant restenosis and Target Vessel Revascularization (TLR) at least during short term follow up, and instant restenosis (ISR) is generally considered to be a stable process. However, recent studies have reported 1/3rd of patients with ISR present with Acute coronary syndrome (ACS).
Objective: We report in this case series, two patients, one presenting with stable angina and another presenting with unstable angina. We compared Optical Coherence Tomography (OCT) analysis of these two subsets of patients.
Findings: In case of stable angina patients the Optical Coherence Tomography (OCT) findings suggested homogenous character of restenotic plaque with high back scatter in majority of tissue, regular lumen shape, no micro vessels, no intraluminal material. There was nothing suggestive of intimal rupture, no Thin Cap Fibrous Atheroma (TCFA) containing neo intima.
In case of unstable angina patients, OCT characterization further reveals both homogenous layered and heterogeneous characteristic of restenotic plaque with mixed high and low backscatter along with irregular lumen shape in between. Presence of micro vessels was also noted, and areas of lipid core were noted. There are areas of intimal rupture, TCFAs and presence of macrophages.
Conclusion: In patients of DES instant restenosis, the presentation as stable or unstable patient can be analysed by OCT characterization of the resultant plaque.
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