Stent underexpansion and residual reference segment stenosis are related to stent thrombosis after sirolimus-eluting stent implantation: an intravascular ultrasound study.
OBJECTIVE
We sought to determine the predictors of stent thrombosis after sirolimus-eluting stent (SES) implantation.


BACKGROUND
A number of cases of stent thrombosis have been reported after commercial release of the SES in the "real world," such that the U.S. Food and Drug Administration issued a warning.


METHODS
Fifteen patients who developed stent thrombosis after successful SES implantation were analyzed and compared with 45 matched control patients who had no evidence of stent thrombosis.


RESULTS
Minimum stent cross-sectional area (MSA) (4.3 +/- 1.6 mm(2) vs. 6.2 +/- 1.9 mm(2), p < 0.001) and stent expansion (0.65 +/- 0.18 vs. 0.85 +/- 0.14, p < 0.001) were significantly smaller in the stent thrombosis group than in the matched control patients. There was no significant difference in the rate of SES malapposition between the groups. However, the presence of a significant residual reference segment stenosis was more common in the stent thrombosis group compared with the matched control group (67% vs. 9%, p < 0.001). Independent predictors of stent thrombosis were stent underexpansion (p = 0.03) and a significant residual reference segment stenosis (p = 0.02).


CONCLUSIONS
Stent underexpansion and residual reference segment stenosis are associated with stent thrombosis after successful SES implantation.
Fujii
Kenichi
K
Cardiovascular Research Foundation, Columbia University Medical Center, 55 East 59th Street, New York, NY 10022, USA.
Carlier
Stéphane G
SG
Mintz
Gary S
GS
Yang
Yi-ming
YM
Moussa
Issam
I
Weisz
Giora
G
Dangas
George
G
Mehran
Roxana
R
Lansky
Alexandra J
AJ
Kreps
Edward M
EM
Collins
Michael
M
Stone
Gregg W
GW
Moses
Jeffrey W
JW
Leon
Martin B
MB
D000368:Aged; D016022:Case-Control Studies; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000000981:diagnostic imaging / Q000628:therapy*; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D009519:New York City / Q000453:epidemiology; D012189:Retrospective Studies; D020123:Sirolimus / Q000008:administration & dosage*; D015607:Stents; D017211:Treatment Failure; D018084:Ultrasonography, Interventional
D007166:Immunosuppressive Agents; D020123:Sirolimus