Serial intravascular ultrasound assessment of very late stent thrombosis after sirolimus-eluting stent placement

• Published in: Journal of cardiology Vol. 64; no. 4; pp. 279 - 284
• Main Authors: Yamanaga, Kenshi, MD, Tsujita, Kenichi, MD, PhD, Shimomura, Hideki, MD, PhD, Nakamura, Yoshinori, MD, PhD, Ogura, Yuji, MD, Onoue, Yoshiro, MD, Chazono, Naomi, MD, Nagata, Takeshi, MD, Morisaki, Shogo, MD, Kudo, Takashi, MD, PhD, Yamada, Yoshihiro, MD, PhD, Komura, Naohiro, MD, PhD, Miyazaki, Takashi, MD, Akasaka, Tomonori, MD, Horio, Eiji, MD, Sato, Koji, MD, Arima, Yuichiro, MD, PhD, Kojima, Sunao, MD, PhD, FJCC, Kaikita, Koichi, MD, PhD, FJCC, Tayama, Shinji, MD, PhD, Hokimoto, Seiji, MD, PhD, FJCC, Ogawa, Hisao, MD, PhD, FJCC
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.10.2014
• Subjects: Aged; Cardiovascular; Case-Control Studies; Coronary Angiography; Coronary Thrombosis - diagnostic imaging; Coronary Thrombosis - etiology; Drug-eluting stent; Drug-Eluting Stents - adverse effects; Female; Humans; Imaging; Intravascular ultrasound; Male; Medication Adherence; Middle Aged; Platelet Aggregation Inhibitors - therapeutic use; Remodeling; Sirolimus - administration & dosage; Thrombosis; Time Factors; Ultrasonography, Interventional; Vascular Remodeling; Intravascular ultrasound; Remodeling; Thrombosis; Imaging; Drug-eluting stent
• ISSN: 0914-5087; 1876-4738
• DOI: 10.1016/j.jjcc.2014.02.008

Abstract Purpose In-stent restenosis has been decreasing through the introduction of drug-eluting stents (DES). On the other hand, adverse events such as very late stent thrombosis (VLST) and late catch-up phenomenon can occur especially with sirolimus-eluting stents (SES, first-generation DES) in long-term follow-up. However, the precise mechanisms underlying VLST have not been well investigated in vivo. Methods and results From 2004 to 2010, 2034 SES were implanted in 1656 patients and caused eight VLST (0.48% per patient) at Fukuoka Tokushukai Medical Center. Of these, serial intravascular ultrasound (IVUS) images (post-stent implantation and at the time of VLST onset) were obtained from three patients with VLST. Comparing them with eight control patients with SES implanted, the vascular reactivity of VLST patients was analyzed. Eight VLST happened 50 ± 15 months after stent implantation and three of the eight patients with VLST had not taken aspirin daily. There were no differences in minimum stent area, maximum external elastic membrane (EEM) area, and stent edge (distal and proximal) EEM area in post-procedural IVUS images. Compared with the control group patients, ΔEEM area (10.6 ± 3.4 mm2 vs. 1.7 ± 1.9 mm2 , p = 0.01) and vessel expansion ratio (185.6 ± 40.3% vs. 112.0 ± 12.1%, p = 0.01) were significantly greater in the VLST group based on the greater peri-stent plaque expansion (262.1 ± 72.8% vs. 118.7 ± 21.2%, p = 0.01). Conclusion Our serial IVUS study showed that the vascular positive remodeling after SES implantation is one of the most probable morphological mechanisms for VLST development.