Black Hole Seen on IVUS in Coronary Restenosis

Black hole seen on IVUS in coronary restenosis

Black holes are sonolucent areas within areas of restenosis seen on intravascular ultrasound. Regions near the IVUS catheter and towards the adventitia are more echogenic while the area in between is sonolucent and are called black holes.

It has been reported after late restenosis after implantation of sirolimus eluting stent by Sudhir et al  [1]. Yoshitaka et al mentions that the black hole phenomenon as a homogenous echolucent appearance by intravascular ultrasound. They have further discussed the angioscopic and pathological assessment of the black hole phenomenon [2]. Their experience was also after sirolimus eluting stent implantation.

In one study, the typical ‘black hole’ appearance by IVUS in a case of sirolimus eluting stent corresponded to a fibrin rich tissue by histology. The tissue was transluscent tissue on visualization by coronary angioscopy [3].

References

  1. Sudhir Ratore, Hitoshi Matsuo, Takahiko Suzuki. Black Hole Phenomenon Observed on IVUS After Late Restenosis Following Sirolimus-Eluting Stent Implantation. J Invasive Cardiol. 2009 Aug;21(8):426-7.
  2. Yoshitaka Shiratori, Yuji Oikawa, Junji Yajima. “Black Hole” Restenosis After Sirolimus-Eluting Stent Implantation. J Invasive Cardiol. 2008 Aug;20(8):E253-5.
  3. Yuji Oikawa, Junji Yajima, Marco A Costa, Shunsuke Matsuno, Masafumi Akabane, Ryuichi Funada, Toshiro Inaba, Yuya Nakagawa, Michinari Nakamura, Kazuyuki Nagashima, Hajime Kirigaya, Ken Ogasawara, Hitoshi Sawada, Tadanori Aizawa. Intravascular Ultrasound, Angioscopic and Histopathological Characterisation of Heterogeneous Patterns of Restenosis After Sirolimus-Eluting Stent Implantation: Insights Into Potential “Thromborestenosis” Phenomenon. EuroIntervention. 2010 Aug;6(3):380-7.