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J Am Heart Assoc. 2017 Apr 14;6(4). pii: e005386. doi: 10.1161/JAHA.116.005386.

Characteristics of Earlier Versus Delayed Presentation of Very Late Drug-Eluting Stent Thrombosis: An Optical Coherence Tomographic Study.

Lee SY1, Ahn JM2, Mintz GS3, Hur SH4, Choi SY5, Kim SW6, Cho JM7, Hong SJ8, Kim JW9, Hong YJ10, Lee SG11, Shin DH12,13, Kim JS12,13, Kim BK12,13, Ko YG12,13, Choi D12,13, Jang Y12,13,14, Park SJ15, Hong MK16,13,14.

Author information

1
Department of Internal Medicine, Sanbon Hospital, Wonkwang University College of Medicine, Gunpo, Korea.
2
Department of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan, Seoul, Korea.
3
Cardiovascular Research Foundation, New York, NY.
4
Department of Cardiology, Keimyung University College of Medicine, Daegu, Korea.
5
Division of Cardiology, Ajou University Hospital, Suwon, Korea.
6
Department of Cardiology, Chung-Ang University Medical Center, Seoul, Korea.
7
Division of Cardiology, Kyung Hee University School of Medicine, Seoul, Korea.
8
Department of Cardiology, Korea University Anam Hospital, Seoul, Korea.
9
Department of Cardiology, Korea University Guro Hospital, Seoul, Korea.
10
Departments of Cardiology, Chonnam National University Medical School, Gwangju, Korea.
11
Department of Cardiology, Ulsan University College of Medicine, Ulsan, Korea.
12
Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea.
13
Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea.
14
Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Korea.
15
Department of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan, Seoul, Korea mkhong61@yuhs.ac sjpark@amc.seoul.kr.
16
Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea mkhong61@yuhs.ac sjpark@amc.seoul.kr.

Abstract

BACKGROUND:

The pathophysiology underlying very late drug-eluting stent (DES) thrombosis is not sufficiently understood. Using optical coherence tomography, we investigated characteristics of very late stent thrombosis (VLST) according to different onset times.

METHODS AND RESULTS:

A total of 98 patients from 10 South Korean hospitals who underwent optical coherence tomography for evaluation of very late DES thrombosis were retrospectively included in analyses. VLST occurred at a median of 55.1 months after DES implantation. All patients were divided into 2 equal groups of earlier versus delayed presentation of VLST, according to median onset time. In total, 27 patients were treated with next-generation DES and 71 with first-generation DES. Based on optical coherence tomography findings at thrombotic sites, main VLST mechanisms were as follows, in descending order: neoatherosclerosis (34.7%), stent malapposition (33.7%), and uncovered struts without stent malapposition or evagination (24.5%). Compared with patients with earlier VLST, patients with delayed VLST had lower frequency of uncovered struts without stent malapposition or evagination (34.7% versus 14.3%, respectively; P=0.019). Conversely, the frequency of neoatherosclerosis was higher in patients with delayed versus earlier VLST (44.9% versus 24.5%, respectively; P=0.034). The frequency of stent malapposition was not different between patients with earlier and delayed VLST (34.7% versus 32.7%, respectively; P=0.831). The frequency of stent malapposition, evagination, and uncovered struts was still half of delayed VLST.

CONCLUSIONS:

The pathological mechanisms of very late DES thrombosis changed over time. Delayed neointimal healing remained a substantial substrate for VLST, even long after DES implantation.

KEYWORDS:

coronary artery disease; drug‐eluting stent; optical coherence tomography

PMID:
28411245
PMCID:
PMC5533030
DOI:
10.1161/JAHA.116.005386
[Indexed for MEDLINE]
Free PMC Article

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