title: In vivo optical coherence tomography of very late drug-eluting stent thrombosis compared with late in-stent restenosis.
abstract: BACKGROUND
  Autopsy findings have suggested delayed arterial healing as a primary cause of very late stent thrombosis (VLST) after drug-eluting stent (DES) implantation.
  
  
  RESULTS
  Optical coherence tomography of DES-treated lesions that developed VLST (n = 6) was compared with that of DES-treated lesions that developed late in-stent restenosis (L-ISR: n = 32) among patients with recurrent ischemia >1 year after DES implantation (mean, 37 ± 17 months), and with the stented segment without any evidence of VLST or L-ISR (no-event: n = 20; mean, 38 ± 19 months). The proportion of uncovered and malapposed struts in each stented segment was evaluated. A total of 961 frames, 9,763 struts were analyzed. The proportion of uncovered struts was higher in the VLST group than in the L-ISR group and the no-event group (29.2 ± 22.8%, 7.9 ± 9.7%, and 7.6 ± 8.0%, respectively; P = 0.0002). The proportion of malapposed struts was higher in the VLST group than in the no-event group (7.3 ± 8.7% vs 1.1 ± 2.4%, P = 0.01). Two patients in the VLST group had lower rates of uncovered and malapposed struts, but this involved lipid-laden-like neointima with disruptions.
  
  
  CONCLUSIONS
  Delayed neointimal coverage and incomplete stent apposition were frequently observed in the DES-treated lesions that developed very late thrombosis. Lipid-laden-like neointima with disruption within the DES may be another possible mechanism for very late thrombosis.
authors: Department of Cardiology, Tokushima Red Cross Hospital, Komatsushima, Japan. shinzoo@tokushima-med.jrc.or.jp
authors: Shinichiro
authors: S
authors: Miyazaki
authors: Yoshikazu
authors: Y
authors: Hiasa
authors: Takefumi
authors: T
authors: Takahashi
authors: Yudai
authors: Y
authors: Yano
authors: Tomoko
authors: T
authors: Minami
authors: Naotsugu
authors: N
authors: Murakami
authors: Michiko
authors: M
authors: Mizobe
authors: Yohei
authors: Y
authors: Tobetto
authors: Takafumi
authors: T
authors: Nakagawa
authors: Po-Min
authors: PM
authors: Chen
authors: Riyo
authors: R
authors: Ogura
authors: Hitoshi
authors: H
authors: Miyajima
authors: Kenichiro
authors: K
authors: Yuba
authors: Shinobu
authors: S
authors: Hosokawa
authors: Koichi
authors: K
authors: Kishi
authors: Ryuji
authors: R
authors: Ohtani
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000473:pathology / Q000628:therapy; D023903:Coronary Restenosis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology*; D003328:Coronary Thrombosis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology*; D054855:Drug-Eluting Stents / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy; D058426:Neointima / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology; D020123:Sirolimus / Q000627:therapeutic use; D013997:Time Factors; D041623:Tomography, Optical Coherence
chemical_list: D007166:Immunosuppressive Agents; D020123:Sirolimus