title: IVUS-guided treatment strategies for definite late and very late stent thrombosis.
abstract: OBJECTIVE
  Our aim was to describe the intravascular ultrasound (IVUS) findings of patients with late stent thrombosis (ST) undergoing percutaneous intervention, and to compare the pre- and post-intervention IVUS findings of patients treated with balloon angioplasty (BA) vs. additional stent implantation (ASI).
  
  
  RESULTS
  A total of 117 patients with late ST imaged with IVUS were included (51.2% had drug-eluting stent ST). Treatment was left to the operator's discretion: BA was performed in 53.8% and ASI in 46.2%. Pre-intervention, incomplete stent apposition (ISA) was observed in 69.8% vs. 63.0% (p=0.43), underexpansion in 33.3% vs. 18.5% (p=0.07) and restenosis in 15.9% vs. 27.8% (p=0.12), respectively. Post-intervention, persistent ISA was observed in 37.2% vs. 60.9% (p=0.03) and malapposition volume decreased by 43.6% vs. 2.6% (p=0.03). Persistent underexpansion was observed in 9.3% vs. 17.4% (p=0.26); however, the stent expansion index was largely increased with BA (from 0.75 to 0.88) compared to ASI (from 0.80 to 0.82); p=0.046. At two years, recurrent ST was observed in one (1.7%) vs. four (7.7%) patients, respectively; p=0.09.
  
  
  CONCLUSIONS
  Non-optimal IVUS criteria of stent implantation are often observed in patients with late ST. Treatment of late ST with BA leads to a larger reduction of malapposition and underexpansion with respect to ASI and is associated with favourable outcomes.
authors.affiliation: Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Universitat de Barcelona, L'Hospitalet de Llobregat, Spain.
authors.forename: Josep
authors.initials: J
authors.lastname: Gomez-Lara
authors.forename: Neus
authors.initials: N
authors.lastname: Salvatella
authors.forename: Nieves
authors.initials: N
authors.lastname: Gonzalo
authors.forename: Felipe
authors.initials: F
authors.lastname: Hernández-Hernández
authors.forename: Eduard
authors.initials: E
authors.lastname: Fernandez-Nofrerias
authors.forename: Angel
authors.initials: A
authors.lastname: Sánchez-Recalde
authors.forename: Teresa
authors.initials: T
authors.lastname: Bastante
authors.forename: Ana
authors.initials: A
authors.lastname: Marcano
authors.forename: Rafael
authors.initials: R
authors.lastname: Romaguera
authors.forename: José-Luis
authors.initials: JL
authors.lastname: Ferreiro
authors.forename: Gerard
authors.initials: G
authors.lastname: Roura
authors.forename: Luis
authors.initials: L
authors.lastname: Teruel
authors.forename: Albert
authors.initials: A
authors.lastname: Ariza-Solé
authors.forename: Faustino
authors.initials: F
authors.lastname: Miranda-Guardiola
authors.forename: Vera
authors.initials: V
authors.lastname: Rodríguez García-Abad
authors.forename: Joan-Antoni
authors.initials: JA
authors.lastname: Gomez-Hospital
authors.forename: Fernando
authors.initials: F
authors.lastname: Alfonso
authors.forename: Angel
authors.initials: A
authors.lastname: Cequier
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods; D017023:Coronary Angiography / Q000379:methods; D003328:Coronary Thrombosis / Q000188:drug therapy / Q000601:surgery*; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020123:Sirolimus / Q000627:therapeutic use; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000379:methods
chemical_list: D020123:Sirolimus