title: Incidence and Morphological Predictors of Intrastent Coronary Thrombus After Drug-Eluting Stent Implantation (from a Multicenter Registry).
abstract: The mechanisms responsible for late and very late stent thrombosis remain incompletely understood. This study aimed to evaluate the incidence and morphologic predictors of intrastent thrombus in patients after drug-eluting stent (DES) implantation using optical coherence tomography (OCT). A total of 208 patients with 262 DES who underwent follow-up OCT examination >6 months after DES implantation were included. The detailed vascular morphology including characteristics of neointima was analyzed. Thrombus was identified in 24 patients (11.5%) 11 months after DES implantation. Minimal lumen cross-sectional area was significantly smaller in the thrombus group than in the nonthrombus group (2.9 ± 1.7 vs 4.6 ± 2.0 mm(2); p <0.001). No difference was found in the frequency of uncovered or malapposed struts between the 2 groups. Thin-cap fibroatheroma (20.6% vs 0.1%; p <0.001) and heterogeneous neointima (22.2% vs 9.0%; p = 0.001) were more frequently detected in the thrombus group compared to the nonthrombus group. Second-generation DES showed lower incidence of thrombus, uncovered struts, and extrastent lumen compared with first-generation DES. In conclusion, the present OCT study revealed that smaller lumen cross-sectional area and neointimal morphology are important factors associated with intrastent thrombus. Second-generation DES demonstrated improved arterial healing and a lower incidence of intrastent thrombus compared with first-generation DES.
authors.affiliation: Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Lei
authors.initials: L
authors.lastname: Gao
authors.affiliation: Department of Medicine, Queen Mary Hospital, Hong Kong University, Hong Kong, China.
authors.forename: Stephen
authors.initials: S
authors.lastname: Lee
authors.affiliation: Division of Cardiology, Kyung-Hee University, Seoul, South Korea.
authors.forename: Chong-Jin
authors.initials: CJ
authors.lastname: Kim
authors.affiliation: Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Yoshiyasu
authors.initials: Y
authors.lastname: Minami
authors.affiliation: Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Ong
authors.affiliation: The First Department of Medicine, Nara Medical University, Nara, Japan.
authors.forename: Tsunenari
authors.initials: T
authors.lastname: Soeda
authors.affiliation: Cardiology Department, Concord Repatriation General Hospital, Sydney, Australia.
authors.forename: Harry
authors.initials: H
authors.lastname: Lowe
authors.affiliation: Department of Cardiology, Ajou University Hospital, Suwon, South Korea.
authors.forename: So-Yeon
authors.initials: SY
authors.lastname: Choi
authors.affiliation: Division of Cardiovascular Disease and Department of Internal Medicine, Mayo College of Medicine, Rochester, Minnesota.
authors.forename: Amir
authors.initials: A
authors.lastname: Lerman
authors.affiliation: Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Jay
authors.initials: J
authors.lastname: Lee
authors.affiliation: Biostatistics Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Hang
authors.initials: H
authors.lastname: Lee
authors.affiliation: Cardiovascular Medicine Department, Kawasaki Medical School, Kurashiki, Japan.
authors.forename: Shiro
authors.initials: S
authors.lastname: Uemura
authors.affiliation: Department of Cardiology, The 2(nd) Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China. Electronic address: yubodr@163.com.
authors.forename: Bo
authors.initials: B
authors.lastname: Yu
authors.affiliation: Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Division of Cardiology, Kyung-Hee University, Seoul, South Korea. Electronic address: IJANG@mgh.harvard.edu.
authors.forename: Ik-Kyung
authors.initials: IK
authors.lastname: Jang
mesh_terms: D054058:Acute Coronary Syndrome / Q000601:surgery*; D017546:Angioscopy / Q000379:methods*; D001315:Australia / Q000453:epidemiology; D002681:China / Q000453:epidemiology; D003328:Coronary Thrombosis / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D003331:Coronary Vessels / Q000473:pathology*; D054855:Drug-Eluting Stents / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012042:Registries; D056910:Republic of Korea / Q000453:epidemiology; D041623:Tomography, Optical Coherence / Q000379:methods*; D014481:United States / Q000453:epidemiology