A case of lipid core plaque progression and rupture at the edge of a coronary stent: elucidating the mechanisms of drug-eluting stent failure.

Understanding 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. The patient was a 52-year-old man with hypertension, dyslipidemia, a family history of coronary artery disease, and prior myocardial infarction in 1998. The patient