title: Failure Mechanisms and Neoatherosclerosis Patterns in Very Late Drug-Eluting and Bare-Metal Stent Thrombosis.
abstract: There are few clinical studies on the pathophysiological mechanisms of very late stent thrombosis (VLST). We report optical coherence tomography findings in patients with VLST and compare the findings between bare-metal stents (BMS) and drug-eluting stents (DES).
  
  
  
  We conducted a registry of stent thrombosis at 4 North American centers with optical coherence tomography imaging programs SAFE registry (The Study of Late Stent Failure Evaluated by OCT). Images were acquired in 61 patients (42 DES and 19 BMS) presenting with definite VLST. The median duration from implantation to VLST presentation was 51.4 months in the DES and 69.9 months in the BMS group (P=0.011). Uncovered and malapposed struts were observed in 70.5% (43/61) and 62.3% (38/61) of patients, respectively, whereas neoatherosclerosis was revealed in 49.2% (30/61). Stent underexpansion was observed in 42.4% of patients. Malapposed struts and stent underexpansion were more frequently demonstrated in DES than in BMS patients, whereas neoatherosclerosis was frequently observed in BMS (40.5% in DES and 68.4% in BMS; P=0.056). The percentage of frames with neoatherosclerosis was lower in DES than in BMS (15.56% [12.24-28.57] versus, 56.41% [40.74-70.00], respectively; P<0.001). Maximum consecutive lipid neointima length was shorter in DES than in BMS (2.4 [1.2-3.6] and 5.3 [3.0-7.0] mm; P=0.011).
  
  
  
  Optical coherence tomography imaging demonstrated that VLST in DES and BMS had a wide variety of abnormal findings, such as neoatherosclerosis, uncovered strut, and malapposed strut. Neoatherosclerosis and lipid neointima were more frequently observed and had more longitudinal extension in BMS compared with DES.
authors: From the Cardiovascular Imaging Core Laboratory, Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Cleveland, OH (D.N., G.F.A., W.W., M.S., R.A., R.T., M.L., A.F., E.M., S.N., M.A.C., H.G.B.); Heart and Vascular Institute, University of Pittsburgh Medical Center, PA (C.T.); McMaster University and Population Health Research Institute, Hamilton Health Sciences, Ontario, Canada (T.S.); Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson (W.W.); and Division of Cardiology, Vancouver General Hospital, University of British Columbia, Canada (A.F.).
authors: Daisuke
authors: D
authors: Nakamura
authors: From the Cardiovascular Imaging Core Laboratory, Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Cleveland, OH (D.N., G.F.A., W.W., M.S., R.A., R.T., M.L., A.F., E.M., S.N., M.A.C., H.G.B.); Heart and Vascular Institute, University of Pittsburgh Medical Center, PA (C.T.); McMaster University and Population Health Research Institute, Hamilton Health Sciences, Ontario, Canada (T.S.); Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson (W.W.); and Division of Cardiology, Vancouver General Hospital, University of British Columbia, Canada (A.F.). guilherme.attizzani@uhhospitals.org.
authors: Guilherme F
authors: GF
authors: Attizzani
authors: From the Cardiovascular Imaging Core Laboratory, Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Cleveland, OH (D.N., G.F.A., W.W., M.S., R.A., R.T., M.L., A.F., E.M., S.N., M.A.C., H.G.B.); Heart and Vascular Institute, University of Pittsburgh Medical Center, PA (C.T.); McMaster University and Population Health Research Institute, Hamilton Health Sciences, Ontario, Canada (T.S.); Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson (W.W.); and Division of Cardiology, Vancouver General Hospital, University of British Columbia, Canada (A.F.).
authors: Catalin
authors: C
authors: Toma
authors: From the Cardiovascular Imaging Core Laboratory, Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Cleveland, OH (D.N., G.F.A., W.W., M.S., R.A., R.T., M.L., A.F., E.M., S.N., M.A.C., H.G.B.); Heart and Vascular Institute, University of Pittsburgh Medical Center, PA (C.T.); McMaster University and Population Health Research Institute, Hamilton Health Sciences, Ontario, Canada (T.S.); Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson (W.W.); and Division of Cardiology, Vancouver General Hospital, University of British Columbia, Canada (A.F.).
authors: Tej
authors: T
authors: Sheth
authors: From the Cardiovascular Imaging Core Laboratory, Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Cleveland, OH (D.N., G.F.A., W.W., M.S., R.A., R.T., M.L., A.F., E.M., S.N., M.A.C., H.G.B.); Heart and Vascular Institute, University of Pittsburgh Medical Center, PA (C.T.); McMaster University and Population Health Research Institute, Hamilton Health Sciences, Ontario, Canada (T.S.); Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson (W.W.); and Division of Cardiology, Vancouver General Hospital, University of British Columbia, Canada (A.F.).
authors: Wei
authors: W
authors: Wang
authors: From the Cardiovascular Imaging Core Laboratory, Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Cleveland, OH (D.N., G.F.A., W.W., M.S., R.A., R.T., M.L., A.F., E.M., S.N., M.A.C., H.G.B.); Heart and Vascular Institute, University of Pittsburgh Medical Center, PA (C.T.); McMaster University and Population Health Research Institute, Hamilton Health Sciences, Ontario, Canada (T.S.); Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson (W.W.); and Division of Cardiology, Vancouver General Hospital, University of British Columbia, Canada (A.F.).
authors: Mohamad
authors: M
authors: Soud
authors: From the Cardiovascular Imaging Core Laboratory, Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Cleveland, OH (D.N., G.F.A., W.W., M.S., R.A., R.T., M.L., A.F., E.M., S.N., M.A.C., H.G.B.); Heart and Vascular Institute, University of Pittsburgh Medical Center, PA (C.T.); McMaster University and Population Health Research Institute, Hamilton Health Sciences, Ontario, Canada (T.S.); Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson (W.W.); and Division of Cardiology, Vancouver General Hospital, University of British Columbia, Canada (A.F.).
authors: Reem
authors: R
authors: Aoun
authors: From the Cardiovascular Imaging Core Laboratory, Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Cleveland, OH (D.N., G.F.A., W.W., M.S., R.A., R.T., M.L., A.F., E.M., S.N., M.A.C., H.G.B.); Heart and Vascular Institute, University of Pittsburgh Medical Center, PA (C.T.); McMaster University and Population Health Research Institute, Hamilton Health Sciences, Ontario, Canada (T.S.); Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson (W.W.); and Division of Cardiology, Vancouver General Hospital, University of British Columbia, Canada (A.F.).
authors: Ramyashree
authors: R
authors: Tummala
authors: From the Cardiovascular Imaging Core Laboratory, Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Cleveland, OH (D.N., G.F.A., W.W., M.S., R.A., R.T., M.L., A.F., E.M., S.N., M.A.C., H.G.B.); Heart and Vascular Institute, University of Pittsburgh Medical Center, PA (C.T.); McMaster University and Population Health Research Institute, Hamilton Health Sciences, Ontario, Canada (T.S.); Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson (W.W.); and Division of Cardiology, Vancouver General Hospital, University of British Columbia, Canada (A.F.).
authors: Milana
authors: M
authors: Leygerman
authors: From the Cardiovascular Imaging Core Laboratory, Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Cleveland, OH (D.N., G.F.A., W.W., M.S., R.A., R.T., M.L., A.F., E.M., S.N., M.A.C., H.G.B.); Heart and Vascular Institute, University of Pittsburgh Medical Center, PA (C.T.); McMaster University and Population Health Research Institute, Hamilton Health Sciences, Ontario, Canada (T.S.); Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson (W.W.); and Division of Cardiology, Vancouver General Hospital, University of British Columbia, Canada (A.F.).
authors: Anas
authors: A
authors: Fares
authors: From the Cardiovascular Imaging Core Laboratory, Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Cleveland, OH (D.N., G.F.A., W.W., M.S., R.A., R.T., M.L., A.F., E.M., S.N., M.A.C., H.G.B.); Heart and Vascular Institute, University of Pittsburgh Medical Center, PA (C.T.); McMaster University and Population Health Research Institute, Hamilton Health Sciences, Ontario, Canada (T.S.); Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson (W.W.); and Division of Cardiology, Vancouver General Hospital, University of British Columbia, Canada (A.F.).
authors: Emile
authors: E
authors: Mehanna
authors: From the Cardiovascular Imaging Core Laboratory, Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Cleveland, OH (D.N., G.F.A., W.W., M.S., R.A., R.T., M.L., A.F., E.M., S.N., M.A.C., H.G.B.); Heart and Vascular Institute, University of Pittsburgh Medical Center, PA (C.T.); McMaster University and Population Health Research Institute, Hamilton Health Sciences, Ontario, Canada (T.S.); Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson (W.W.); and Division of Cardiology, Vancouver General Hospital, University of British Columbia, Canada (A.F.).
authors: Setsu
authors: S
authors: Nishino
authors: From the Cardiovascular Imaging Core Laboratory, Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Cleveland, OH (D.N., G.F.A., W.W., M.S., R.A., R.T., M.L., A.F., E.M., S.N., M.A.C., H.G.B.); Heart and Vascular Institute, University of Pittsburgh Medical Center, PA (C.T.); McMaster University and Population Health Research Institute, Hamilton Health Sciences, Ontario, Canada (T.S.); Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson (W.W.); and Division of Cardiology, Vancouver General Hospital, University of British Columbia, Canada (A.F.).
authors: Anthony
authors: A
authors: Fung
authors: From the Cardiovascular Imaging Core Laboratory, Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Cleveland, OH (D.N., G.F.A., W.W., M.S., R.A., R.T., M.L., A.F., E.M., S.N., M.A.C., H.G.B.); Heart and Vascular Institute, University of Pittsburgh Medical Center, PA (C.T.); McMaster University and Population Health Research Institute, Hamilton Health Sciences, Ontario, Canada (T.S.); Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson (W.W.); and Division of Cardiology, Vancouver General Hospital, University of British Columbia, Canada (A.F.).
authors: Marco A
authors: MA
authors: Costa
authors: From the Cardiovascular Imaging Core Laboratory, Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Cleveland, OH (D.N., G.F.A., W.W., M.S., R.A., R.T., M.L., A.F., E.M., S.N., M.A.C., H.G.B.); Heart and Vascular Institute, University of Pittsburgh Medical Center, PA (C.T.); McMaster University and Population Health Research Institute, Hamilton Health Sciences, Ontario, Canada (T.S.); Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson (W.W.); and Division of Cardiology, Vancouver General Hospital, University of British Columbia, Canada (A.F.).
authors: Hiram G
authors: HG
authors: Bezerra
mesh_terms: D000368:Aged; D003328:Coronary Thrombosis / Q000000981:diagnostic imaging* / Q000209:etiology / Q000473:pathology; D003331:Coronary Vessels / Q000000981:diagnostic imaging* / Q000473:pathology; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D008297:Male; D008670:Metals; D008875:Middle Aged; D009656:North America; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation*; D058226:Plaque, Atherosclerotic; D011237:Predictive Value of Tests; D011474:Prosthesis Design; D012042:Registries; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D041623:Tomography, Optical Coherence; D017211:Treatment Failure
chemical_list: D008670:Metals
keywords: neoatherosclerosis; optical coherence tomography; percutaneous coronary intervention; stents; thrombosis