title: Mechanisms of stent thrombosis analysed by optical coherence tomography: insights from the national PESTO French registry.
abstract: OBJECTIVE
  Angiography has limited value for identifying the causes of stent thrombosis (ST). We studied a large cohort of patients by optical coherence tomography (OCT) to explore ST characteristics and mechanisms.
  
  
  RESULTS
  A prospective multicentre registry was screened for patients with confirmed ST. Optical coherence tomography was performed after initial intervention to the culprit lesion (in 69% of cases in a deferred procedure). Stent thrombosis was classified as acute (AST), sub-acute (SAST), late (LST), and very late (VLST). Optical coherence tomography records were analysed in a central core lab. The analysis included 120 subjects aged 61.7 [51.4-70.7]; 89% male. Very late ST was the clinical presentation in 75%, LST in 6%, SAST in 15%, and AST in 4% of patients. Bare metal stents (BMS) were used in 39%, drug-eluting stents (DES) in 59% and bioresorbable vascular scaffolds in 2% of the cases. Optical coherence tomography identified an underlying morphological abnormality in 97% of cases, including struts malapposition (34%), neoatherosclerotic lesions (22%), major stent underexpansion (11%), coronary evagination (8%), isolated uncovered struts (8%), edge-related disease progression (8%), and neointimal hyperplasia (4%). Ruptured neoatherosclerotic lesions were more frequent with BMS than with DES (36 vs. 14%, P = 0.005), whereas coronary evaginations were more frequent with DES than with BMS (12 vs. 2%, P = 0.04). LST + VLST were mainly related to malapposition (31%) and neoatherosclerosis (28%), while prominent mechanisms for AST + SAST were malapposition (48%) and underexpansion (26%).
  
  
  CONCLUSIONS
  In patients with confirmed ST, OCT imaging identified an underlying morphological abnormality in 97% of cases.
authors.affiliation: Cardiology Department, CHU Clermont-Ferrand, Clermont-Ferrand 63000, France Cardio Vascular Interventional Therapy and Imaging (CaVITI), UMR CNRS 6284, Auvergne University, Clermont-Ferrand, France gsouteyrand@chu-clermontferrand.fr.
authors.forename: Geraud
authors.initials: G
authors.lastname: Souteyrand
authors.affiliation: Cardiology Department, Institut Mutualiste Montsouris, Paris, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Amabile
authors.affiliation: Cardiology Department, CH Annecy, Annecy, France.
authors.forename: Lionel
authors.initials: L
authors.lastname: Mangin
authors.affiliation: Cardiology Department, CHU Clermont-Ferrand, Clermont-Ferrand 63000, France Cardio Vascular Interventional Therapy and Imaging (CaVITI), UMR CNRS 6284, Auvergne University, Clermont-Ferrand, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Chabin
authors.affiliation: Cardiology Department, CHU Besançon, Besançon, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Meneveau
authors.affiliation: Cardiology Department, CHU Nimes, Nimes, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Cayla
authors.affiliation: Cardiology Department, CHU Grenoble, Grenoble, France.
authors.forename: Gerald
authors.initials: G
authors.lastname: Vanzetto
authors.affiliation: Cardiology Department, CH Henri Duffaut, Avignon, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Barnay
authors.affiliation: Cardiology Department, CH La Rochelle-Re-Aunis, La Rochelle, France.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Trouillet
authors.affiliation: Cardiology Department, Hospices Civils de Lyon, Bron, France.
authors.forename: Gilles
authors.initials: G
authors.lastname: Rioufol
authors.affiliation: Cardiology Department, CH Chartres, Chartres, France.
authors.forename: Gregoire
authors.initials: G
authors.lastname: Rangé
authors.affiliation: Cardiology Department, CHU Henri Mondor-Assistance Publique-Hôpitaux de Paris, Creteil, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Teiger
authors.affiliation: Cardiology Department, CH St Brieuc, St Brieuc, France.
authors.forename: Regis
authors.initials: R
authors.lastname: Delaunay
authors.affiliation: Cardiology Department, St Luc-St Joseph hospital, Lyon, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Dubreuil
authors.affiliation: Department of Cardiology, CHU Rangueil, Toulouse, France.
authors.forename: Thibault
authors.initials: T
authors.lastname: Lhermusier
authors.affiliation: Bio-Statistics Unit, délégation recherche clinique & innovation, CHU de Clermont-Ferrand, France.
authors.forename: Aurélien
authors.initials: A
authors.lastname: Mulliez
authors.affiliation: Cardiology Department, CHU Poitiers, Poitiers, France.
authors.forename: Sebastien
authors.initials: S
authors.lastname: Levesque
authors.affiliation: Cardiology Department, CH Annecy, Annecy, France.
authors.forename: Loic
authors.initials: L
authors.lastname: Belle
authors.affiliation: Cardiology Department, Institut Mutualiste Montsouris, Paris, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Caussin
authors.affiliation: Cardiology Department, CHU Clermont-Ferrand, Clermont-Ferrand 63000, France Cardio Vascular Interventional Therapy and Imaging (CaVITI), UMR CNRS 6284, Auvergne University, Clermont-Ferrand, France.
authors.forename: Pascal
authors.initials: P
authors.lastname: Motreff
mesh_terms: D054058:Acute Coronary Syndrome / Q000628:therapy; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D003328:Coronary Thrombosis / Q000000981:diagnostic imaging / Q000209:etiology*; D054855:Drug-Eluting Stents; D005260:Female; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011183:Postoperative Complications / Q000000981:diagnostic imaging; D011446:Prospective Studies; D011475:Prosthesis Failure; D012042:Registries; D041623:Tomography, Optical Coherence / Q000379:methods
chemical_list: D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors
keywords: Bare metal stent; Drug-eluting stent; Optical coherence tomography; Stent thrombosis