Incomplete stent apposition and very late stent thrombosis after drug-eluting stent implantation.
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.


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 > or = 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.
Cook
Stéphane
S
Department of Cardiology, University Hospital Bern, 3010 Bern, Switzerland.
Wenaweser
Peter
P
Togni
Mario
M
Billinger
Michael
M
Morger
Cyrill
C
Seiler
Christian
C
Vogel
Rolf
R
Hess
Otto
O
Meier
Bernhard
B
Windecker
Stephan
S
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D000886:Anthropometry; D017023:Coronary Angiography; D003328:Coronary Thrombosis / Q000000981:diagnostic imaging* / Q000209:etiology; D003331:Coronary Vessels / Q000473:pathology / Q000503:physiopathology; D004343:Drug Implants; D004868:Equipment Failure; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006965:Hyperplasia; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic / Q000706:statistics & numerical data; D017239:Paclitaxel / Q000008:administration & dosage; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data; D020123:Sirolimus / Q000008:administration & dosage; D015607:Stents / Q000009:adverse effects*; D013997:Time Factors; D017539:Tunica Intima / Q000473:pathology; D018084:Ultrasonography, Interventional
D004343:Drug Implants; D017239:Paclitaxel; D020123:Sirolimus