Coronary Edema Demonstrated by Cardiovascular Magnetic Resonance in Patients With Peri-Stent Inflammation and Aneurysm Formation After Treatment by Drug-Eluting Stents

Drug-eluting stents (DES) minimized the occurrence of in-stent restenosis but with a penalty of increased risk of late stent thrombosis.1 In patients with late stent thrombosis, adverse vessel wall reactions such as uncovered and malapposed stent struts, coronary aneurysms, and accelerated neoatherosclerosis2 have been identified. The stent polymer is suspected to induce an inflammatory response,3 resulting in vessel wall abnormalities.Identification of patients with an inflammatory response to DES might be essential in preventing late stent thrombosis. Inflammatory processes increase vessel wall permeability, leading to edema, and both native and peri-stent vessel wall inflammation may be associated with tissue edema. Cardiovascular magnetic resonance (CMR) performed with a T2-weighted short-τ inversion recovery sequence (T2-STIR) has recently been shown to identify localized coronary edema in the culprit artery of patients with acute myocardial infarction.4 Parameters for the ECG-triggered, navigator-gated, dark-blood, T2-STIR fast-spin-echo sequence were as follows: repetition time, 2 RR intervals; echo time, 100 milliseconds; echo train length, twenty 0.68×0.68×8-mm3 voxels; and 2 signal averages. Here we present 3 patients treated with DES (Cypher Select+, Cordis, Johnson & Johnson, Miami Lakes, FL) who demonstrate peri-stent edema as a possible marker of stent-induced coronary inflammation.A 41-year-old woman experienced very late stent thrombosis 15 months after treatment with DES in the proximal left anterior descending …