title: Mechanical abnormalities associated with first- and second-generation drug-eluting stent thrombosis analyzed by optical coherence tomography in the national PESTO French registry.
abstract: OBJECTIVE
  DES thrombosis may be triggered by different mechanisms that are difficult to identify by angiography alone. This work aimed to investigate and compare the characteristics of stent thrombosis (ST) between 1st- and 2nd-generation drug-eluting stents (DES) among a large cohort of patients explored by optical coherence tomography (OCT).
  
  
  RESULTS
  The PESTO study was a prospective national registry involving 29 French catheterization facilities. Patients with acute coronary syndromes were prospectively screened for presence of definite ST and analyzed by OCT after culprit lesion deocclusion. The analysis involved 71 subjects including 34 patients with 1st-generation DES (DES1G) and 35 patients with 2nd-generation DES (DES2G). Most patients (80%) presented with very late stent thrombosis. The median time between initial PCI and ST was longer in DES1G than DES2G patients (3.8 [2.6-6.5] years vs. 1.1 [0.04-2.3] years, p<0.0001). OCT identified an underlying morphological abnormality in 96% of the cases. Significant malapposition was the main abnormality observed either in DES1G (26%) or DES2G patients (35%). Ruptured neoatherosclerotic lesions were more frequently observed with DES1G than with DES2G (26% vs. 3%, p=0.008). There was no significant difference in percentage of malapposed struts and uncovered struts between groups.
  
  
  CONCLUSIONS
  In this registry, DES thrombosis mainly occurred ≥1year after initial PCI. OCT identified a mechanical abnormality in the vast majority of the cases. Similar causes were observed between DES1G and DES2G, but neoatherosclerotic lesions were more common in DES1G.
authors.affiliation: Cardiology Department, Institut Mutualiste Montsouris, Paris, France. Electronic address: nicolas.amabile@imm.fr.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Amabile
authors.affiliation: Cardiology Department, GH La Rochelle-Re-Aunis, La Rochelle, France.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Trouillet
authors.affiliation: Cardiology Department, CHU Jean Minjoz, Besançon, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Meneveau
authors.affiliation: Cardiology Department, CHU Henri Mondor-Assistance Publique-Hôpitaux de Paris, Creteil, France.
authors.forename: Claire Marie
authors.initials: CM
authors.lastname: Tissot
authors.affiliation: Cardiology Department, CH Annecy, Annecy, France.
authors.forename: Loic
authors.initials: L
authors.lastname: Belle
authors.affiliation: Cardiology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Combaret
authors.affiliation: Cardiology Department, CH Albert Schweitzer, Chartres, France.
authors.forename: Grégoire
authors.initials: G
authors.lastname: Range
authors.affiliation: Cardiology Department, CH Henri Duffaut, Avignon, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Pansieri
authors.affiliation: Cardiology Department, CH St Brieuc, St Brieuc, France.
authors.forename: Regis
authors.initials: R
authors.lastname: Delaunay
authors.affiliation: Cardiology Department, CHU Poitiers, Poitiers, France.
authors.forename: Sébastien
authors.initials: S
authors.lastname: Levesque
authors.affiliation: Cardiology Department, CHU Rangueil, Toulouse, France.
authors.forename: Thibault
authors.initials: T
authors.lastname: Lhermusier
authors.affiliation: Cardiology Department, Hospices Civils de Lyon, Bron, France.
authors.forename: François
authors.initials: F
authors.lastname: Derimay
authors.affiliation: Cardiology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France.
authors.forename: Pascal
authors.initials: P
authors.lastname: Motreff
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, France.
authors.forename: Géraud
authors.initials: G
authors.lastname: Souteyrand
mesh_terms: D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000295:instrumentation* / Q000379:methods / Q000401:mortality; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D003328:Coronary Thrombosis / Q000000981:diagnostic imaging* / Q000401:mortality; D054855:Drug-Eluting Stents / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D005602:France; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012042:Registries; D018570:Risk Assessment; D016019:Survival Analysis; D041623:Tomography, Optical Coherence / Q000379:methods*
keywords: Drug-eluting stent; Intracoronary imaging; Neoatherosclerosis; Stent thrombosis