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A 61-year-old man presented with transient dysarthria and left upper extremity numbness. Head MRI showed an acute infarct in the left temporal lobe and multiple old infarcts in the bilateral cortices. A transesophageal echocardiogram revealed a patent foramen ovale with a large shunt. No deep vein thrombosis was found. He suffered a recurrent cerebral infarction while taking antiplatelet therapy. An insertable cardiac monitor was implanted on the 41st day, and the antiplatelet treatment was changed to warfarin. The insertable cardiac monitor did not detect atrial fibrillation, even when the patient had a recurrent transient ischemic attack on the 57th day under warfarin therapy. The patient underwent percutaneous foramen ovale closure on the 63rd day. On postoperative days 18-25, an insertable cardiac monitor detected brief atrial fibrillation, and he took rivaroxaban for three months. Atrial fibrillation may occur secondary to percutaneous patent foramen ovale closure for cryptogenic stroke. The insertable cardiac monitor may help diagnose the pathogenesis of secondary atrial fibrillation and determine the optimal antithrombotic therapy.

Types and characteristics of current-available drug-eluting stents(DES) are introduced in this review. Currently, DESs with agents of "limus family" are mainly used because of their efficacy and safety. Two representative performances, angiographic late loss and incidence of late acquired incomplete stent apposition, are compared between these DESs. Furthermore, patient-to-patient variation in amount of neointimal hyperplasia, which is chiefly associated with clinical outcomes, tends to be larger for the DES with larger average angiographic late loss. Thrombotic complications are unexpectedly more frequent in the DES with larger late loss within first one year according to the randomized clinical trials, however, persistent influences to vascular wall become dominant factors stent thrombosis at very late phases.

Objectives: Incomplete stent apposition (ISA) is frequently observed after sirolimus-eluting stent (SES) implantation. This study investigated the incidence, morphological features, and possible mechanisms of this phenomenon., Methods: Fifty-two lesions in 47 eligible patients were treated with SES and serial intravascular ultrasound (IVUS) assessment at the time of post-intervention and 8-month follow-up. ISA was carefully identified from the IVUS images of these lesions. Specifically, quantitative two dimensional IVUS analysis was performed if the lesions demonstrated ISA, including routine IVUS parameters as well as other measurements related to ISA., Results: Overall, ISA was observed in 13 lesions (25.0%) at follow-up. Persistent ISA (n = 6, 11.5%), defined as ISA consistently observed both at post-intervention and follow-up, and late-acquired ISA (n = 7, 13.5%)were systematically compared. Eighty-three percent of cases of persistent ISA were located around the stent edges, whereas all cases of late-acquired ISA were in the stent body. In the persistent ISA group, no serial changes were observed in the lumen area or external elastic membrane area (EEMA) from post-intervention to follow-up. However, in the late-acquired ISA group, EEMA and lumen area significantly increased from post-intervention to follow-up (EEMA: 13.4 +/- 3.2 vs 17.6 +/- 3.3 mm2, respectively, p < 0.0001 ; lumen area: 6.7 +/- 1.4 vs 9.2 +/- 1.8 mm2, respectively, p = 0.004). No adverse clinical events were observed in either group., Conclusions: ISA was frequently observed during and after SES implantation in clinical practice. No clinical disadvantages were observed during 16 month clinical follow-up periods. Positive remodeling may potentially cause late-acquired ISA.