Neoatherosclerosis with silent plaque rupture in a saphenous vein graft causing no re-flow phenomenon assessed by optical coherence tomography and histopathology

A 79-year-old man with a history of coronary artery bypass grafting 22 years earlier was hospitalized due to stable angina. A bare metal stent was implanted in his saphenous vein graft (SVG) 15 years ago and then, a drug-eluting stent was implanted for the in-stent restenosis 8 years ago. Coronary angiography revealed a severe instent restenosis in the SVG anastomosed to the right coronary artery (Fig. 1A). Optical coherence tomography (OCT) showed plaque fissure, cholesterol crystals, and low-intensity area without attenuation adjacent to the lipid-rich plaque (LRP), which suggested the intraplaque hemorrhage (IPH) (Fig. 1B, a, b). OCT also revealed ...