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Mechanisms of Very Late Drug-Eluting Stent Thrombosis Assessed by Optical Coherence Tomography.

by Garcia-Garcia, Hector M.
Citation: Circulation. 133(7):650-60, 2016 Feb 16..Journal: Circulation.Published: 2016ISSN: 0009-7322.Full author list: Taniwaki M; Radu MD; Zaugg S; Amabile N; Garcia-Garcia HM; Yamaji K; Jorgensen E; Kelbaek H; Pilgrim T; Caussin C; Zanchin T; Veugeois A; Abildgaard U; Juni P; Cook S; Koskinas KC; Windecker S; Raber L.UI/PMID: 26762519.Subject(s): Aged | *Coronary Vessels/pa [Pathology] | Coronary Vessels/su [Surgery] | Cross-Sectional Studies | *Drug-Eluting Stents/ae [Adverse Effects] | Drug-Eluting Stents/st [Standards] | *Drug-Eluting Stents/td [Trends] | Female | Humans | Male | Middle Aged | Prosthesis Failure | *Thrombosis/di [Diagnosis] | *Thrombosis/et [Etiology] | Time Factors | *Tomography, Optical Coherence/mt [Methods]Institution(s): MedStar Heart & Vascular InstituteActivity type: Journal Article.Medline article type(s): Journal Article | Observational Study | Research Support, Non-U.S. Gov'tOnline resources: Click here to access online Digital Object Identifier: http://dx.doi.org/10.1161/CIRCULATIONAHA.115.019071 (Click here) Abbreviated citation: Circulation. 133(7):650-60, 2016 Feb 16.Local Holdings: Available online from MWHC library: 1950 - present, Available in print through MWHC library: 1999 - 2006.Abstract: BACKGROUND: The pathomechanisms underlying very late stent thrombosis (VLST) after implantation of drug-eluting stents (DES) are incompletely understood. Using optical coherence tomography, we investigated potential causes of this adverse event.Abstract: METHODS AND RESULTS: Between August 2010 and December 2014, 64 patients were investigated at the time point of VLST as part of an international optical coherence tomography registry. Optical coherence tomography pullbacks were performed after restoration of flow and analyzed at 0.4 mm. A total of 38 early- and 20 newer-generation drug-eluting stents were suitable for analysis. VLST occurred at a median of 4.7 years (interquartile range, 3.1-7.5 years). An underlying putative cause by optical coherence tomography was identified in 98% of cases. The most frequent findings were strut malapposition (34.5%), neoatherosclerosis (27.6%), uncovered struts (12.1%), and stent underexpansion (6.9%). Uncovered and malapposed struts were more frequent in thrombosed compared with nonthrombosed regions (ratio of percentages, 8.26; 95% confidence interval, 6.82-10.04; P<0.001 and 13.03; 95% confidence interval, 10.13-16.93; P<0.001, respectively). The maximal length of malapposed or uncovered struts (3.40 mm; 95% confidence interval, 2.55-4.25; versus 1.29 mm; 95% confidence interval, 0.81-1.77; P<0.001), but not the maximal or average axial malapposition distance, was greater in thrombosed compared with nonthrombosed segments. The associations of both uncovered and malapposed struts with thrombus were consistent among early- and newer-generation drug-eluting stents.Abstract: CONCLUSIONS: The leading associated findings in VLST patients in descending order were malapposition, neoatherosclerosis, uncovered struts, and stent underexpansion without differences between patients treated with early- and new-generation drug-eluting stents. The longitudinal extension of malapposed and uncovered stent was the most important correlate of thrombus formation in VLST.Copyright © 2016 American Heart Association, Inc.

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