Circulation. 2007;115:2426-2434
doi: 10.1161/CIRCULATIONAHA.106.658237
doi: 10.1161/CIRCULATIONAHA.106.658237
(Circulation. 2007;115:2426-2434.)
© 2007 American Heart Association, Inc.
Interventional Cardiology |
Incomplete Stent Apposition and Very Late Stent Thrombosis After Drug-Eluting Stent Implantation
From the Department of Cardiology, University Hospital Bern, Bern, Switzerland.
Correspondence to Stephan Windecker, MD, Department of Cardiology, University Hospital Bern, 3010 Bern, Switzerland. E-mail stephan.windecker{at}insel.ch
Received August 14, 2006; accepted February 20, 2007.
Background— Stent thrombosis may occur late after drug-eluting stent (DES) implantation, and its cause remains unknown. The present study investigated differences of the stented segment between patients with and without very late stent thrombosis with the use of intravascular ultrasound.
Methods and Results— Since January 2004, patients presenting with very late stent thrombosis (>1 year) after DES implantation underwent intravascular ultrasound. Findings in patients with very late stent thrombosis were compared with intravascular ultrasound routinely obtained 8 months after DES implantation in 144 control patients, who did not experience stent thrombosis for 
2 years. Very late stent thrombosis was encountered in 13 patients at a mean of 630±166 days after DES implantation. Compared with DES controls, patients with very late stent thrombosis had longer lesions (23.9±16.0 versus 13.3±7.9 mm; P<0.001) and stents (34.6±22.4 versus 18.6±9.5 mm; P<0.001), more stents per lesion (1.6±0.9 versus 1.1±0.4; P<0.001), and stent overlap (39% versus 8%; P<0.001). Vessel cross-sectional area was similar for the reference segment (cross-sectional area of the external elastic membrane: 18.9±6.9 versus 20.4±7.2 mm2; P=0.46) but significantly larger for the in-stent segment (28.6±11.9 versus 20.1±6.7 mm2; P=0.03) in very late stent thrombosis patients compared with DES controls. Incomplete stent apposition was more frequent (77% versus 12%; P<0.001) and maximal incomplete stent apposition area was larger (8.3±7.5 versus 4.0±3.8 mm2; P=0.03) in patients with very late stent thrombosis compared with controls.
Conclusions— Incomplete stent apposition is highly prevalent in patients with very late stent thrombosis after DES implantation, suggesting a role in the pathogenesis of this adverse event.
CLINICAL PERSPECTIVE
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|
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|
|
|
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|
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|
|
|
|
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|
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|
|
|
|
|
|
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|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
 |
|
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|
|
|
|
 |
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
 |
|
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|
|
|
|
 |
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
 |
|
 S. H Bhatt and T. H Hauser Very Late Stent Thrombosis After Dual Antiplatelet Therapy Discontinuation in a Patient with a History of Acute Stent Thrombosis Ann. Pharmacother., May 1, 2008; 42(5): 708 - 712. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Y. Honda and P. J. Fitzgerald Frontiers in Intravascular Imaging Technologies Circulation, April 15, 2008; 117(15): 2024 - 2037. [Full Text] [PDF]
|
|
|
|
|
|
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|
|
|
|
|
|
C. Di Mario and P. Barlis Optical Coherence Tomography: A New Tool to Detect Tissue Coverage in Drug-Eluting Stents J. Am. Coll. Cardiol. Intv., April 1, 2008; 1(2): 174 - 175. [Full Text] [PDF]
|
|
|
|
|
|
B. L. van der Hoeven, S.-S. Liem, J. Dijkstra, S. C. Bergheanu, H. Putter, M. L. Antoni, D. E. Atsma, M. Bootsma, K. Zeppenfeld, J. W. Jukema, et al. Stent Malapposition After Sirolimus-Eluting and Bare-Metal Stent Implantation in Patients with ST-Segment Elevation Myocardial Infarction: Acute and 9-Month Intravascular Ultrasound Results of the MISSION! Intervention Study J. Am. Coll. Cardiol. Intv., April 1, 2008; 1(2): 192 - 201. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Colombo and A. Latib Late incomplete stent apposition after drug-eluting stent implantation: a true risk factor or "an innocent bystander"? Heart, March 1, 2008; 94(3): 253 - 254. [Full Text] [PDF]
|
|
|
|
|
|
B. L. van der Hoeven, S.-S. Liem, J. W. Jukema, N. Suraphakdee, H. Putter, J. Dijkstra, D. E. Atsma, M. Bootsma, K. Zeppenfeld, P. V. Oemrawsingh, et al. Sirolimus-eluting stents versus bare-metal stents in patients with ST-segment elevation myocardial infarction: 9-month angiographic and intravascular ultrasound results and 12-month clinical outcome results from the MISSION! Intervention Study. J. Am. Coll. Cardiol., February 12, 2008; 51(6): 618 - 626. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. Romagnoli, G. M. Sangiorgi, J. Cosgrave, E. Guillet, and A. Colombo Drug-eluting stenting the case for post-dilation. J. Am. Coll. Cardiol. Intv., February 1, 2008; 1(1): 22 - 31. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Jabara, N. Chronos, D. Conway, W. Molema, and K. Robinson Evaluation of a novel slow-release Paclitaxel-eluting stent with a bioabsorbable polymeric surface coating. J. Am. Coll. Cardiol. Intv., February 1, 2008; 1(1): 81 - 87. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Alfonso, A. Suarez, M. J. Perez-Vizcayno, R. Moreno, J. Escaned, C. Banuelos, P. Jimenez, E. Bernardo, D. J. Angiolillo, R. Hernandez, et al. Intravascular Ultrasound Findings During Episodes of Drug-Eluting Stent Thrombosis J. Am. Coll. Cardiol., November 20, 2007; 50(21): 2095 - 2097. [Full Text] [PDF]
|
|
|
|
|
|
S. Windecker and B. Meier Late Coronary Stent Thrombosis Circulation, October 23, 2007; 116(17): 1952 - 1965. [Full Text] [PDF]
|
|
|
|
|
|
M.-K. Hong, G. S. Mintz, C. W. Lee, D.-W. Park, S.-W. Lee, Y.-H. Kim, D.-H. Kang, S.-S. Cheong, J.-K. Song, J.-J. Kim, et al. Impact of Late Drug-Eluting Stent Malapposition on 3-Year Clinical Events J. Am. Coll. Cardiol., October 9, 2007; 50(15): 1515 - 1516. [Full Text] [PDF]
|
|
|
|
 |
|
 Mechanisms of Late Drug-Eluting Stent Thrombosis Journal Watch Cardiology, June 13, 2007; 2007(613): 2 - 2. [Full Text]
|
|
|
|
|
|
G. S. Mintz What to Do About Late Incomplete Stent Apposition? Circulation, May 8, 2007; 115(18): 2379 - 2381. [Full Text] [PDF]
|
|