Diagnosis and management of hepatic artery in-stent restenosis after liver transplantation by optical coherence tomography: A case report

Figure 1 Graphic showing patient’s serum levels of direct bilirubin (mg/dL), alkaline phosphatase (U/L) and alanine aminotransferase (U/L); Doppler wave forms and resistive index along time. DBB: Direct bilirubin; ALP: Alkaline phosphatase; ALT: Alanine aminotransferase; RI: Resistance index.

Figure 2 Visceral arteriography and optical coherence tomography. A: Visceral arteriography diagnosis with hepatic artery tortuosity and doubtful significant intra-stent diameter reduction and intrahepatic flow reduction. The yellow arrow indicates the possible stenosis area, to be confirmed further with an intravascular method; B: OCT diagnosis of severe stenosis due neointimal hyperplasia and focal and partial stent fracture; C: OCT diagnosis of stent late malapposition; D: OCT diagnosis of in-stent neointimal hyperplasia and neoatherosclerosis. OCT: Optical coherence tomography.

Figure 3 Visceral arteriography after percutaneous transluminal angioplasty and optical coherence tomography posttreatment. A: Visceral arteriography after percutaneous transluminal angioplasty with drug-eluting stent (Sirolimus) Orsiro 3 mm × 30 mm (Biotronik) showing complete resolution of restenosis and improvement in intrahepatic perfusion; B: Optical coherence tomography posttreatment showing acute gain in luminal area due to complete stent expansion.