Author + information
- Received May 23, 2011
- Revision received September 12, 2011
- Accepted September 15, 2011
- Published online January 1, 2012.
- Giulio Guagliumi, MD⁎,⁎ (, )
- Vasile Sirbu, MD⁎,
- Giuseppe Musumeci, MD⁎,
- Robert Gerber, MD†,
- Giuseppe Biondi-Zoccai, MD⁎,
- Hideyuki Ikejima, MD⁎,
- Elena Ladich, MD‡,
- Nikoloz Lortkipanidze, MD⁎,
- Aleksandre Matiashvili, MD⁎,
- Orazio Valsecchi, MD⁎,
- Renu Virmani, MD‡ and
- Gregg W. Stone, MD§
- ↵⁎Reprint requests and correspondence:
Dr. Giulio Guagliumi, Cardiovascular Department, Ospedali Riuniti di Bergamo, Largo Barozzi 1, Ingresso 14, 24121 Bergamo, Italy
Objectives This study investigated the role of uncovered stent struts on late stent thrombosis (LST) after drug-eluting stent (DES) implantation with optical coherence tomography (OCT).
Background Autopsy studies have identified delayed healing and lack of endothelialization of DES struts as the hallmarks of LST. DES strut coverage has not previously been examined in vivo in patients with LST.
Methods We studied 54 patients, including 18 with DES LST (median 615 days after implant) undergoing emergent percutaneous coronary interventions and 36 matched DES control subjects undergoing routine repeat OCT and intravascular ultrasound (IVUS) who did not experience LST for ≥3 years. Thrombus aspiration was performed during emergent percutaneous coronary intervention before OCT and IVUS assessment.
Results By OCT, patients with LST—compared with control subjects—had a higher percentage of uncovered (median [interquartile range]) (12.27 [5.50 to 23.33] vs. 4.14 [3.00 to 6.22], p < 0.001) and malapposed (4.60 [1.85 to 7.19] vs. 1.81 [0.00 to 2.99], p < 0.001) struts. The mean neointimal thickness was similar in the 2 groups (0.23 ± 0.17 mm vs. 0.17 ± 0.09 mm, p = 0.28). By IVUS, stent expansion was comparable in the 2 groups, although positive remodeling was increased in patients with LST (mean vessel cross-section area 19.4 ± 5.8 mm2 vs. 15.1 ± 4.6 mm2, p = 0.003). Thrombus aspiration demonstrated neutrophils and eosinophils in most cases. By multivariable analysis, the length of segment with uncovered stent struts by OCT and the remodeling index by IVUS were independent predictors of LST.
Conclusions In this in vivo case-controlled study, the presence of uncovered stent struts as assessed by OCT and positive vessel remodeling as imaged by IVUS were associated with LST after DES.
- acute myocardial infarction
- drug-eluting stent(s)
- late stent thrombosis
- optical coherence tomography
- percutaneous coronary intervention
This work was supported by Ospedali Riuniti di Bergamo, Bergamo, Italy. Dr. Guagliumi has received consulting fees from Boston Scientific, Cordis, and Volcano Corporation; and grant support from LightLab Imaging, Medtronic Vascular, Boston Scientific, and Abbott Vascular. Dr. Sirbu has received research grant support from LightLab Imaging. Dr. Virmani has served as a consultant for Medtronic AVE, Abbott Vascular, W. L. Gore, Prescient Medical, CardioMind, Inc., Arsenal Medical, Biosensors International, GlaxoSmithKline, and Lutonix. Atrium Medical Corporation. Dr. Stone serves on the scientific advisory boards for and has received honoraria from Boston Scientific and Abbott Vascular; he receives research support from Volcano Corporation and InfraReDx; and he is a consultant to Medtronic, Abbott Vascular, Boston Scientific, and Volcano Corporation. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received May 23, 2011.
- Revision received September 12, 2011.
- Accepted September 15, 2011.
- American College of Cardiology Foundation