title: Serial intravascular ultrasound assessment of very late stent thrombosis after sirolimus-eluting stent placement.
abstract: OBJECTIVE
  In-stent restenosis has been decreasing through the introduction of drug-eluting stents (DES). On the other hand, adverse events such as very late stent thrombosis (VLST) and late catch-up phenomenon can occur especially with sirolimus-eluting stents (SES, first-generation DES) in long-term follow-up. However, the precise mechanisms underlying VLST have not been well investigated in vivo.
  
  
  RESULTS
  From 2004 to 2010, 2034 SES were implanted in 1656 patients and caused eight VLST (0.48% per patient) at Fukuoka Tokushukai Medical Center. Of these, serial intravascular ultrasound (IVUS) images (post-stent implantation and at the time of VLST onset) were obtained from three patients with VLST. Comparing them with eight control patients with SES implanted, the vascular reactivity of VLST patients was analyzed. Eight VLST happened 50 ± 15 months after stent implantation and three of the eight patients with VLST had not taken aspirin daily. There were no differences in minimum stent area, maximum external elastic membrane (EEM) area, and stent edge (distal and proximal) EEM area in post-procedural IVUS images. Compared with the control group patients, ΔEEM area (10.6 ± 3.4mm(2) vs. 1.7 ± 1.9 mm(2), p=0.01) and vessel expansion ratio (185.6 ± 40.3% vs. 112.0 ± 12.1%, p=0.01) were significantly greater in the VLST group based on the greater peri-stent plaque expansion (262.1 ± 72.8% vs. 118.7 ± 21.2%, p=0.01).
  
  
  CONCLUSIONS
  Our serial IVUS study showed that the vascular positive remodeling after SES implantation is one of the most probable morphological mechanisms for VLST development.
authors.affiliation: Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan; Division of Cardiology, Fukuoka Tokushukai Medical Center, Kasuga, Japan.
authors.forename: Kenshi
authors.initials: K
authors.lastname: Yamanaga
authors.affiliation: Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan. Electronic address: tsujita@kumamoto-u.ac.jp.
authors.forename: Kenichi
authors.initials: K
authors.lastname: Tsujita
authors.affiliation: Division of Cardiology, Fukuoka Tokushukai Medical Center, Kasuga, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Shimomura
authors.affiliation: Division of Cardiology, Fukuoka Tokushukai Medical Center, Kasuga, Japan.
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Nakamura
authors.affiliation: Division of Cardiology, Fukuoka Tokushukai Medical Center, Kasuga, Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Ogura
authors.affiliation: Division of Cardiology, Fukuoka Tokushukai Medical Center, Kasuga, Japan.
authors.forename: Yoshiro
authors.initials: Y
authors.lastname: Onoue
authors.affiliation: Division of Cardiology, Fukuoka Tokushukai Medical Center, Kasuga, Japan.
authors.forename: Naomi
authors.initials: N
authors.lastname: Chazono
authors.affiliation: Division of Cardiology, Fukuoka Tokushukai Medical Center, Kasuga, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Nagata
authors.affiliation: Division of Cardiology, Fukuoka Tokushukai Medical Center, Kasuga, Japan.
authors.forename: Shogo
authors.initials: S
authors.lastname: Morisaki
authors.affiliation: Division of Cardiology, Fukuoka Tokushukai Medical Center, Kasuga, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Kudo
authors.affiliation: Division of Cardiology, Fukuoka Tokushukai Medical Center, Kasuga, Japan.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Yamada
authors.affiliation: Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
authors.forename: Naohiro
authors.initials: N
authors.lastname: Komura
authors.affiliation: Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Miyazaki
authors.affiliation: Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
authors.forename: Tomonori
authors.initials: T
authors.lastname: Akasaka
authors.affiliation: Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
authors.forename: Eiji
authors.initials: E
authors.lastname: Horio
authors.affiliation: Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Sato
authors.affiliation: Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Arima
authors.affiliation: Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
authors.forename: Sunao
authors.initials: S
authors.lastname: Kojima
authors.affiliation: Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Kaikita
authors.affiliation: Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
authors.forename: Shinji
authors.initials: S
authors.lastname: Tayama
authors.affiliation: Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
authors.forename: Seiji
authors.initials: S
authors.lastname: Hokimoto
authors.affiliation: Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
authors.forename: Hisao
authors.initials: H
authors.lastname: Ogawa
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D017023:Coronary Angiography; D003328:Coronary Thrombosis / Q000000981:diagnostic imaging* / Q000209:etiology*; D054855:Drug-Eluting Stents / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D020123:Sirolimus / Q000008:administration & dosage*; D013997:Time Factors; D018084:Ultrasonography, Interventional; D066253:Vascular Remodeling
chemical_list: D010975:Platelet Aggregation Inhibitors; D020123:Sirolimus
keywords: Drug-eluting stent; Imaging; Intravascular ultrasound; Remodeling; Thrombosis