Acute coronary closure after stenting: a lesson from intravascular ultrasound.

Intravascular ultrasound (IVUS) is an imaging modality more sensitive for defining suboptimal stent deployment issues compared with conventional angiographic imaging. We report on a patient with unstable angina who underwent stent deployment using IVUS guidance. Despite an acceptable angiographic result, intrastent thrombus, incomplete expansion and an edge/marginal dissection were seen by IVUS examination. Both the incomplete expansion and the intrastent thrombus were successfully treated. The dissection, however, was not treated in the catheterization laboratory. This mechanical injury pattern at the stent edge led to vessel occlusion 4 h post-procedure.