title: Usefulness of Intravascular Ultrasound for Predicting Risk of Intraprocedural Stent Thrombosis.
abstract: Intraprocedural stent thrombosis (IPST) is a rare complication of percutaneous coronary intervention that leads to poor outcomes; however, the factors contributing to IPST remain largely unknown. Accordingly, we used intravascular ultrasound (IVUS) to examine the lesion characteristics in patients with IPST. We retrospectively analyzed 1,504 consecutive stent-implanted lesions in 1,324 patients (326 with ST-segment elevation myocardial infarction [STEMI], 403 patients with non-ST-segment elevation acute coronary syndrome [NSTE-ACS], and 595 patients with stable angina). Of these, IPST occurred in 5 patients during percutaneous coronary intervention (0.4% per patient; 3 with STEMI, 2 with NSTE-ACS). The IVUS characteristics of plaques that developed IPST were compared with those of controls without the evidence of IPST (non-IPST; n = 15) who were matched by age, gender, lesion location, and clinical presentation (STEMI, NSTE-ACS, or stable angina). All 5 lesions that led to IPST had ruptured plaques with positive remodeling and attenuation. Plaque rupture was also observed in 40% of the non-IPST group. Multiple plaque ruptures in the culprit lesion were more common in the IPST group (80% vs 7%; p <0.01). The maximum cavity area was larger in the IPST group than in the non-IPST group having plaque rupture (4.6 mm(2) [interquartile range, 4.3 to 6.5] vs 2.4 mm(2) [1.8 to 2.9]; p <0.01). In conclusion, we found using IVUS that multiple plaque ruptures with larger cavities more often evolved into IPST.
authors.affiliation: Department of Cardiology, Kitaishikai Hospital, Ozu, Japan.
authors.forename: Toru
authors.initials: T
authors.lastname: Morofuji
authors.affiliation: Department of Cardiology, Kitaishikai Hospital, Ozu, Japan. Electronic address: inaba226@gmail.com.
authors.forename: Shinji
authors.initials: S
authors.lastname: Inaba
authors.affiliation: Department of Cardiology, Uwajima City Hospital, Uwajima, Japan.
authors.forename: Tatsuro
authors.initials: T
authors.lastname: Hitsumoto
authors.affiliation: Department of Cardiology, Kitaishikai Hospital, Ozu, Japan.
authors.forename: Kayo
authors.initials: K
authors.lastname: Takahashi
authors.affiliation: Department of Cardiology, Kitaishikai Hospital, Ozu, Japan.
authors.forename: Hiroe
authors.initials: H
authors.lastname: Aisu
authors.affiliation: Department of Cardiology, Kitaishikai Hospital, Ozu, Japan.
authors.forename: Haruhiko
authors.initials: H
authors.lastname: Higashi
authors.affiliation: Department of Cardiology, Kitaishikai Hospital, Ozu, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Saito
authors.affiliation: Department of Cardiology, Uwajima City Hospital, Uwajima, Japan.
authors.forename: Kiyotaka
authors.initials: K
authors.lastname: Ohshima
authors.affiliation: Department of Cardiology, Uwajima City Hospital, Uwajima, Japan.
authors.forename: Shuntaro
authors.initials: S
authors.lastname: Ikeda
authors.affiliation: Department of Cardiology, Uwajima City Hospital, Uwajima, Japan.
authors.forename: Mareomi
authors.initials: M
authors.lastname: Hamada
authors.affiliation: Department of Cardiology, Kitaishikai Hospital, Ozu, Japan.
authors.forename: Takumi
authors.initials: T
authors.lastname: Sumimoto
mesh_terms: D054058:Acute Coronary Syndrome / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001241:Aspirin / Q000008:administration & dosage; D000077144:Clopidogrel; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000601:surgery*; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects*; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity; D015607:Stents / Q000009:adverse effects*; D013927:Thrombosis / Q000453:epidemiology / Q000209:etiology*; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D018084:Ultrasonography, Interventional
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin