title: Intravascular ultrasound assessed incomplete stent apposition and stent fracture in stent thrombosis after bare metal versus drug-eluting stent treatment the Nordic Intravascular Ultrasound Study (NIVUS).
abstract: BACKGROUND
  This prospective multicenter registry used intravascular ultrasound (IVUS) in patients with definite stent thrombosis (ST) to compare rates of incomplete stent apposition (ISA), stent fracture and stent expansion in patients treated with drug-eluting (DES) versus bare metal (BMS) stents. ST is a rare, but potential life threatening event after coronary stent implantation. The etiology seems to be multifactorial.
  
  
  METHODS
  124 patients with definite ST were assessed by IVUS during the acute ST event. The study was conducted in 15 high-volume percutaneous coronary intervention -centers in the Nordic-Baltic countries.
  
  
  RESULTS
  In early or late ST there were no differences in ISA between DES and BMS. In very late ST, ISA was a more frequent finding in DES than in BMS (52% vs.16%; p=0.005) and the maximum ISA area was larger in DES compared to BMS (1.1 ± 2.3mm(2) vs. 0.1 ± 0.5mm(2); p=0.004). Further, ISA was more prevalent in sirolimus-eluting than in paclitaxel-eluting stents (58% vs. 37%; p=0.02). Stent fractures were found both in DES (16%) and BMS (24%); p=0.28, and not related to time of stent thrombosis occurrence. For stents with nominal diameters ≥ 2.75 mm, 38% of the DES and 22% of the BMS had a minimum stent area of less than 5mm(2); p=0.14.
  
  
  CONCLUSIONS
  Very late stent thrombosis was more prevalent and associated with more extensive ISA in DES than in BMS treated patients. Stent fracture was a common finding in ST after DES and BMS implantation.
authors.affiliation: Heart Center, Tampere University Hospital, Tampere, Finland; Department of Internal Medicine, Savonlinna Central Hospital, Savonlinna, Finland.
authors.forename: Petteri
authors.initials: P
authors.lastname: Kosonen
authors.forename: Saila
authors.initials: S
authors.lastname: Vikman
authors.forename: Lisette Okkels
authors.initials: LO
authors.lastname: Jensen
authors.forename: Jens Flensted
authors.initials: JF
authors.lastname: Lassen
authors.forename: Jan
authors.initials: J
authors.lastname: Harnek
authors.forename: Göran K
authors.initials: GK
authors.lastname: Olivecrona
authors.forename: Andrejs
authors.initials: A
authors.lastname: Erglis
authors.forename: Eigil
authors.initials: E
authors.lastname: Fossum
authors.forename: Matti
authors.initials: M
authors.lastname: Niemelä
authors.forename: Kari
authors.initials: K
authors.lastname: Kervinen
authors.forename: Antti
authors.initials: A
authors.lastname: Ylitalo
authors.forename: Mikko
authors.initials: M
authors.lastname: Pietilä
authors.forename: Jens
authors.initials: J
authors.lastname: Aaroe
authors.forename: Thomas
authors.initials: T
authors.lastname: Kellerth
authors.forename: Kari
authors.initials: K
authors.lastname: Saunamäki
authors.forename: Per
authors.initials: P
authors.lastname: Thayssen
authors.forename: Lars
authors.initials: L
authors.lastname: Hellsten
authors.forename: Leif
authors.initials: L
authors.lastname: Thuesen
authors.forename: Kari
authors.initials: K
authors.lastname: Niemelä
mesh_terms: D000368:Aged; D001454:Baltic States / Q000453:epidemiology; D054855:Drug-Eluting Stents / Q000009:adverse effects*; D004868:Equipment Failure; D005260:Female; D006801:Humans; D008297:Male; D008670:Metals / Q000009:adverse effects*; D008875:Middle Aged; D011446:Prospective Studies; D012042:Registries; D012537:Scandinavian and Nordic Countries / Q000453:epidemiology; D015607:Stents / Q000009:adverse effects; D013927:Thrombosis / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000379:methods
chemical_list: D008670:Metals