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(Figure 1C). After perfusion fixation of the heart under the normal diastolic pressure by 10% buffered formalin for 24 h, epicardial coronary arteries were removed from the heart. The whole stent segment was embedded in plastic (Technovit 8100; Heraeus Kulzer, Wehrheim, Germany) with the stent struts. Histological sections stained by hematoxylin-eosin and Masson’s trichrome showed a convex mass lesion (Figure 2A) composed of cholesterin crystals, macrophage foam cells and necrotic debris over the stent struts (Figure 2B). Although we could not confirm the endothelial cell coverage due to the technical difficulties of immunohistochemistry using the plastic embedded sections, the luminal surface of the mass was partially covered with thin and flat cells, consistent with endothelial cells. Part of the luminal surface, however, lacked the cell coverage with fibrin A 70-year-old man was hospitalized due to polymyositis and died of pneumonia 1 week after admission. Sirolimus-eluting bioresorbable polymer coated stent (Ultimaster; Terumo, Tokyo, Japan) had been implanted in the circumflex artery 2 months previously. He had been prescribed aspirin 100 mg/day and clopidogrel 75 mg/day. An autopsy was performed followed by ex vivo intravascular ultrasound (IVUS; Terumo), optical frequency domain imaging (OFDI; Terumo) and coronary angioscopy (CAS; FiberTech, Tokyo, Japan). IVUS and OFDI showed a convex-shaped mass with echo attenuation, and protruding mass with a smooth surface accompanied by high backscattering within the stent-implanted segment, respectively (Figure 1A,B; Movie S1). CAS showed a yellowish polypoid lesion over the stent struts. Red thrombus adhesion was observed at the base of the protruding mass lesion

Protruding In-Stent Mass After Bioresorbable Polymer Sirolimus-Eluting Stent ― Ex Vivo Intravascular Imaging and Histopathology ―