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Optical coherence tomography findings of very late stent thrombosis after drug-eluting stent implantation

Authors
Ko, YG; Kim, DM; Cho, JM; Choi, SY; Yoon, JH; Kim, JS; Kim, BK; Choi, D; Jang, Y; Hong, MK
Citation
The international journal of cardiovascular imaging, 28(4):715-723, 2012
Journal Title
The international journal of cardiovascular imaging
ISSN
1569-57941875-8312
Abstract
Previous optical coherence tomography (OCT) studies in patients with drug-eluting stents (DESs)-related very late stent thrombosis (VLST) were scarce. Therefore, we investigated OCT findings of VLST after implantation of DESs. Using OCT, we analyzed the status of stent struts and neointimal characteristics in 18 patients who developed VLST after DES implantation. These results were compared to those in 57 patients with neointimal hyperplasia causing >40% diameter stenosis. Lipid-laden neointima was defined as a region with marked signal attenuation and a diffuse border. Four (22.2%) of 18 patients with VLST had ruptured and lipid-laden neointima inside DESs without uncovered or malapposed stent struts. In the remaining 14 patients who developed VLST without neointimal rupture, uncovered and malapposed struts were observed in nine and seven patients, respectively, and lipid-laden neointima in four patients. Lipid-laden neointima was more frequently observed in four patients with neointimal rupture than in 14 patients without neointimal rupture (100% vs. 28.6%, respectively, P = 0.023). Of 57 patients with neointimal hyperplasia, eight (14.0%) had lipid-laden neointima. Time to OCT study after DES implantation was significantly longer in the eight patients with lipid-laden neointima than in 49 patients without lipid-laden neointima (45.5 ± 17.7 months vs. 11.7 ± 7.2 months, respectively, P 1 year after DES implantation. In addition to uncovered or malapposed struts, rupture of lipid-laden neointima inside DESs was identified in some patients with DES-related VLST.
MeSH terms
AdultAgedAngioplasty, Balloon, Coronary/adverse effects/*instrumentationCardiovascular Agents/administration & dosageChi-Square DistributionCoronary AngiographyCoronary Artery Disease/metabolism/pathology/*therapyCoronary Thrombosis/etiology/metabolism/*pathologyCoronary Vessels/metabolism/*pathology*Drug-Eluting StentsFemaleHumansHyperplasiaLipid MetabolismMaleMiddle AgedNeointima/metabolism/*pathologyPaclitaxel/administration & dosagePredictive Value of TestsProsthesis DesignRepublic of KoreaRisk AssessmentRisk FactorsSirolimus/administration & dosage/analogs & derivativesTime Factors*Tomography, Optical CoherenceTreatment Outcome
DOI
10.1007/s10554-011-9905-3
PMID
21656060
Appears in Collections:
Journal Papers > School of Medicine / Graduate School of Medicine > Cardiology
AJOU Authors
최, 소연
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