title: Mechanical complications of everolimus-eluting stents associated with adverse events: an intravascular ultrasound study.
abstract: OBJECTIVE
  Mechanical complications contribute to bare metal and first-generation drug-eluting stent (DES) failure. However, the importance of the mechanical complications of second-generation DES remains unclear. We report mechanical complications associated with everolimus-eluting stent (EES) failures.
  
  
  RESULTS
  We retrospectively analysed 177 consecutive EES-treated lesions in 136 patients who underwent intravascular ultrasound (IVUS) at follow-up. Mechanical complications were identified in 17 patients (five stable angina, 10 unstable angina, two non-ST-elevation myocardial infarction [NSTEMI] without angiographic thrombus). Fifteen (88.2%) were treated with repeat revascularisation. By IVUS, there were 16 focal (94.1%) and one diffuse (5.9%) in-stent restenoses. Complete stent fracture with separation was seen in only one, partial stent fracture with separation was seen in three, and in 13 there was longitudinal deformation (n=2) or stent strut fracture (n=11) with overlapping of the proximal and distal stent fragments. In 13 EES with evidence of overlapping in the setting of either fracture or deformation, there was a 35.5±12.2% smaller stent area compared to the adjacent proximal and distal stent fragments, and >50% neointimal hyperplasia in 12 (92.3%).
  
  
  CONCLUSIONS
  We found EES mechanical complications, often followed by longitudinal deformation or fracture leading to excessive neointimal hyperplasia, in-stent restenosis, and repeat revascularisation.
authors.affiliation: Cardiovascular Research Foundation, New York, NY, USA.
authors.forename: Shinji
authors.initials: S
authors.lastname: Inaba
authors.forename: Gary S
authors.initials: GS
authors.lastname: Mintz
authors.forename: Kyeong Ho
authors.initials: KH
authors.lastname: Yun
authors.forename: Tadayuki
authors.initials: T
authors.lastname: Yakushiji
authors.forename: Takehisa
authors.initials: T
authors.lastname: Shimizu
authors.forename: Soo-Jin
authors.initials: SJ
authors.lastname: Kang
authors.forename: Philippe
authors.initials: P
authors.lastname: Généreux
authors.forename: Giora
authors.initials: G
authors.lastname: Weisz
authors.forename: Leroy E
authors.initials: LE
authors.lastname: Rabbani
authors.forename: Jeffrey W
authors.initials: JW
authors.lastname: Moses
authors.forename: Gregg W
authors.initials: GW
authors.lastname: Stone
authors.forename: Akiko
authors.initials: A
authors.lastname: Maehara
mesh_terms: D054855:Drug-Eluting Stents / Q000009:adverse effects*; D000068338:Everolimus; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D020123:Sirolimus / Q000008:administration & dosage / Q000031:analogs & derivatives*; D018084:Ultrasonography, Interventional / Q000379:methods*
chemical_list: D000068338:Everolimus; D020123:Sirolimus