Premium
Late and very late coronary stent thrombosis: Intravascular ultrasound findings and associations with antiplatelet therapy
Author(s) -
Pesarini Gabriele,
Dandale Rajesh,
Rigamonti Antonio,
Pighi Michele,
Zivelonghi Carlo,
Mugnolo Antonio,
Ferrero Valeria,
Vassanelli Corrado,
Ribichini Flavio
Publication year - 2013
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.24938
Subject(s) - medicine , intravascular ultrasound , cardiology , stent , thrombosis , myocardial infarction , percutaneous coronary intervention , occlusion , surgery
Background and Objective Late and very‐late stent occlusion remains a serious complication of coronary stenting. Despite their high anti‐restenotic efficacy, drug‐eluting stents (DES) have been associated to more late‐thrombosis as compared to bare‐metal stents (BMS). The aim of this study is to analyze the clinical presentation, angiographic, and intravascular ultrasound (IVUS) findings in patients with late or very late stent thrombosis and the relationship with the antiplatelet regimen. Methods and Results Between January 2007 and December 2011, 34 consecutive patients with clinical syndromes compatible with late or very‐late stent occlusion were studied with IVUS during emergency catheterization; 25 had DES and 9 had BMS. Thrombotic total occlusion was more common in DES (16 = 64%) than BMS patients (2 = 22%; P = 0.02) and ST‐segment elevation myocardial infarction was the predominant clinical presentation in the former group (60% compared to 22%; P = 0.05). The time elapsed between implantation and failure was much longer in DES patients: 33 ± 22 versus 17 ± 14 months for BMS; P = 0.05. IVUS analysis showed a higher incidence of incomplete stent apposition (ISA) in the DES group compared to the BMS group (56% vs. 11%; P = 0.005) and in‐stent plaque rupture was the most common finding in the BMS group (78%). In DES group, ISA was found more frequently in patients still under dual antiplatelet therapy (71%). Conclusions Very late DES failure often causes ST‐elevation myocardial infarction; these very late events may not correlate with the interruption of antiplatelet therapy. Severe, late acquired ISA belongs to DES and is frequently observed in patients with very late DES thrombosis. © 2013 Wiley Periodicals, Inc.