A Case of Lipid Core Plaque Progression and Rupture at the Edge of a Coronary Stent

U nderstanding the mechanisms of coronary drug-eluting stent (DES) failure remains relevant in light of concerns brought on by clinical reports of life-threatening late and very late stent thrombosis and by autopsy studies showing delayed and incomplete healing inside the stents, which may be related to underlying necrotic lipid core. 1 Frequency-domain optical coherence tomography, also known as optical frequency-domain imaging (OFDI), is a new intracoronary imaging technology that enables 3-dimensional visualization of coronary structure in vivo at a resolution (6 m) sufficient to identify many microscopic features of the coronary wall and stents. 2 Here, we present a case of late DES failure that was imaged by OFDI at the time of stent implantation and 15 months later on presentation with unstable angina.