title: Optical coherence tomography findings of very late stent thrombosis after drug-eluting stent implantation.
abstract: Previous optical coherence tomography (OCT) studies in patients with drug-eluting stents (DESs)-related very late stent thrombosis (VLST) were scarce. Therefore, we investigated OCT findings of VLST after implantation of DESs. Using OCT, we analyzed the status of stent struts and neointimal characteristics in 18 patients who developed VLST after DES implantation. These results were compared to those in 57 patients with neointimal hyperplasia causing >40% diameter stenosis. Lipid-laden neointima was defined as a region with marked signal attenuation and a diffuse border. Four (22.2%) of 18 patients with VLST had ruptured and lipid-laden neointima inside DESs without uncovered or malapposed stent struts. In the remaining 14 patients who developed VLST without neointimal rupture, uncovered and malapposed struts were observed in nine and seven patients, respectively, and lipid-laden neointima in four patients. Lipid-laden neointima was more frequently observed in four patients with neointimal rupture than in 14 patients without neointimal rupture (100% vs. 28.6%, respectively, P = 0.023). Of 57 patients with neointimal hyperplasia, eight (14.0%) had lipid-laden neointima. Time to OCT study after DES implantation was significantly longer in the eight patients with lipid-laden neointima than in 49 patients without lipid-laden neointima (45.5 ± 17.7 months vs. 11.7 ± 7.2 months, respectively, P < 0.001). Lipid-laden neointima was detected in some patients with neointimal hyperplasia > 1 year after DES implantation. In addition to uncovered or malapposed struts, rupture of lipid-laden neointima inside DESs was identified in some patients with DES-related VLST.
authors.affiliation: Division of Cardiology, Severance Cardiovascular Center, Yonsei University College of Medicine, 250 Seongsanno, Seodaemun-gu, Seoul, 120-752, Korea.
authors.forename: Young-Guk
authors.initials: YG
authors.lastname: Ko
authors.forename: Dong-Min
authors.initials: DM
authors.lastname: Kim
authors.forename: Jin Man
authors.initials: JM
authors.lastname: Cho
authors.forename: So Yeon
authors.initials: SY
authors.lastname: Choi
authors.forename: Jung Han
authors.initials: JH
authors.lastname: Yoon
authors.forename: Jung-Sun
authors.initials: JS
authors.lastname: Kim
authors.forename: Byeong-Keuk
authors.initials: BK
authors.lastname: Kim
authors.forename: Donghoon
authors.initials: D
authors.lastname: Choi
authors.forename: Yangsoo
authors.initials: Y
authors.lastname: Jang
authors.forename: Myeong-Ki
authors.initials: MK
authors.lastname: Hong
mesh_terms: D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation*; D002317:Cardiovascular Agents / Q000008:administration & dosage; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000378:metabolism / Q000473:pathology / Q000628:therapy*; D003328:Coronary Thrombosis / Q000209:etiology / Q000378:metabolism / Q000473:pathology*; D003331:Coronary Vessels / Q000378:metabolism / Q000473:pathology*; D054855:Drug-Eluting Stents; D000068338:Everolimus; D005260:Female; D006801:Humans; D006965:Hyperplasia; D050356:Lipid Metabolism; D008297:Male; D008875:Middle Aged; D058426:Neointima / Q000378:metabolism / Q000473:pathology*; D017239:Paclitaxel / Q000008:administration & dosage; D011237:Predictive Value of Tests; D011474:Prosthesis Design; D056910:Republic of Korea; D018570:Risk Assessment; D012307:Risk Factors; D020123:Sirolimus / Q000008:administration & dosage / Q000031:analogs & derivatives; D013997:Time Factors; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome
chemical_list: D002317:Cardiovascular Agents; D000068338:Everolimus; C489443:zotarolimus; D017239:Paclitaxel; D020123:Sirolimus