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

Authors
Lee, SY | Ahn, JM | Mintz, GS | Hur, SH | Choi, SY  | Kim, SW | Cho, JM | Hong, SJ | Kim, JW | Hong, YJ | Lee, SG | Shin, DH | Kim, JS | Kim, BK | Ko, YG | Choi, D | Jang, Y | Park, SJ | Hong, MK
Citation
Journal of the American Heart Association, 6(4). : e005386-e005386, 2017
Journal Title
Journal of the American Heart Association
ISSN
2047-9980
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.
MeSH

DOI
10.1161/JAHA.116.005386
PMID
28411245
Appears in Collections:
Journal Papers > School of Medicine / Graduate School of Medicine > Cardiology
Ajou Authors
최, 소연
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