Post-intervention IVUS is not predictive for very late in-stent thrombosis in drug-eluting stents.
OBJECTIVE
Stent thrombosis is a life-threatening complication associated with sudden death and acute myocardial infarction. Histopathologic studies have linked the occurrence of very late stent thrombosis in drug-eluting stents (DES) with delayed endothealisation and stent malapposition. Our aim was to investigate if late stent malapposition in DES could be predicted by immediate postintervention intra-vascular ultrasonography (IVUS).


RESULTS
From our MISSION! database of 184 consecutive patients with ST-elevation myocardial infarction (STEMI) who had immediate post-intervention and nine-month follow-up IVUS examinations we prospectively identified three patients with very late (> 365 days) and definite (with angiographic evidence) in-stent thrombosis in DES. Patients had completed the twelve-month clopidogrel-aspirin dual treatment period, two of them were under aspirin therapy while the third patient had aspirin temporarily discontinued before planned surgery. When assessed by serial documentary (immediate post-intervention and nine-month) IVUS, all three patients demonstrated stent malapposition at nine months: in two cases the malapposition was acquired (immediate post-intervention IVUS showed a well apposed stent) and one case presented persistent malapposition (the stent was found malapposed both at immediate post-intervention and nine-month follow-up IVUS).


CONCLUSIONS
Immediate post-intervention IVUS showing no malapposition does not guarantee an uneventful course after DES implantation.
Bergheanu
Sandrin C
SC
Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
Van der Hoeven
Bas L
BL
Hassan
Ayman K M
AK
Dijkstra
Jouke
J
Rosendaal
Frits R
FR
Liem
Su-San
SS
Schalij
Martin J
MJ
Van der Bom
Johanna G
JG
Jukema
J Wouter
JW
D000328:Adult; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects*; D017023:Coronary Angiography; D003328:Coronary Thrombosis / Q000000981:diagnostic imaging* / Q000209:etiology; D054855:Drug-Eluting Stents / Q000009:adverse effects*; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000601:surgery*; D011237:Predictive Value of Tests; D011475:Prosthesis Failure; D013997:Time Factors; D018084:Ultrasonography, Interventional / Q000379:methods*