title: Stent underexpansion and residual reference segment stenosis are related to stent thrombosis after sirolimus-eluting stent implantation: an intravascular ultrasound study.
abstract: 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.
authors.affiliation: Cardiovascular Research Foundation, Columbia University Medical Center, 55 East 59th Street, New York, NY 10022, USA.
authors.forename: Kenichi
authors.initials: K
authors.lastname: Fujii
authors.forename: Stéphane G
authors.initials: SG
authors.lastname: Carlier
authors.forename: Gary S
authors.initials: GS
authors.lastname: Mintz
authors.forename: Yi-ming
authors.initials: YM
authors.lastname: Yang
authors.forename: Issam
authors.initials: I
authors.lastname: Moussa
authors.forename: Giora
authors.initials: G
authors.lastname: Weisz
authors.forename: George
authors.initials: G
authors.lastname: Dangas
authors.forename: Roxana
authors.initials: R
authors.lastname: Mehran
authors.forename: Alexandra J
authors.initials: AJ
authors.lastname: Lansky
authors.forename: Edward M
authors.initials: EM
authors.lastname: Kreps
authors.forename: Michael
authors.initials: M
authors.lastname: Collins
authors.forename: Gregg W
authors.initials: GW
authors.lastname: Stone
authors.forename: Jeffrey W
authors.initials: JW
authors.lastname: Moses
authors.forename: Martin B
authors.initials: MB
authors.lastname: Leon
mesh_terms: 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
chemical_list: D007166:Immunosuppressive Agents; D020123:Sirolimus