Late acquired incomplete stent apposition: incidence, mechanisms and clinical implications.
Late acquired incomplete stent apposition (LAISA) is an intravascular ultrasound (IVUS) finding that has been associated with late and particularly very late drug-eluting stent (DES) thrombosis. The underlying mechanism appears to be regional positive remodelling due to inflammation necrosis related with DES components. Incidence is higher for DES (10-12%) compared to bare-metal stents (4%) in native vessels, with no data in saphenous vein grafts. Large LAISA has been found in 60-77% of cases with DES late thrombosis studied with IVUS. However, clinical follow-up studies of cases with routinely detected LAISA either do not show a relationship to thrombosis or only reflect a trend, although when taken as a whole, that trend is significant. There is no evidence that correction of LAISA should be a target for secondary or repeated revascularisation. Benefits and risks of LAISA correction are unknown.
de la Torre Hernandez
Jose M
JM
Unidad de Hemodinámica y Cardiología Intervencionista, Hospital Universitario, Marqués de Valdecilla, Santander, Spain. he1thj@humv.es
D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation*; D003324:Coronary Artery Disease / Q000628:therapy*; D054855:Drug-Eluting Stents; D006801:Humans; D008670:Metals; D011474:Prosthesis Design; D011475:Prosthesis Failure; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy; D013997:Time Factors; D017211:Treatment Failure; D018084:Ultrasonography, Interventional
D008670:Metals