Impact of angiographic peri-stent contrast staining (PSS) on late adverse events after sirolimus-eluting stent implantation: an observation from the multicenter j-Cypher registry PSS substudy

Abstract

This study sought to assess clinical significance of angiographic peri-stent contrast staining (PSS) after sirolimus-eluting stent (SES) implantation in a large multicenter study with 5-year follow-up. The j-Cypher PSS substudy is a multicenter study including 5712 patients (7838 lesions) who underwent follow-up angiographic study within 12 months after SES implantation. Late acquired PSS was observed in 184 patients (3.2 %) or 194 lesions (2.5 %). Independent risk factors of PSS were chronic total occlusion and left anterior descending artery lesion, while negative risk factors were in-stent restenosis, diabetes mellitus, ≥70 years of age, and left circumflex coronary artery lesion. Cumulative incidence of definite very late stent thrombosis (VLST) at 4 years after the index follow-up angiography in lesions with PSS was significantly higher than that in lesions without PSS (5.3 versus 0.7 %, P < 0.0001). Late target-lesion revascularization (TLR) was also more frequently observed in the PSS group (13 versus 6.9 %, P = 0.01), while late TLR for restenosis excluding those TLR procedures for VLST tended to be higher in the PSS group (9.9 versus 6.3 %; P = 0.15). PSS found in 2.5 % of lesions within 12 months after SES implantation was associated with higher risk for subsequent VLST.

Comparison of Long‐Term Clinical Outcomes of Lesions Exhibiting Focal and Segmental Peri‐Stent Contrast Staining

“…CTO is a risk factor for PSS and consistent with the findings of the present study because longer lesions with CTO were more frequent in patients with segmental PSS. Furthermore, uncovered struts, malapposed struts, and red thrombus are frequently observed in lesions with PSS .…”

“…In the present study, the cumulative incidence of TLR, excluding TLR procedures for treating ST, was significantly higher in association with segmental PSS than that previously reported . As mentioned above, uncovered or malapposed struts leading to incomplete endothelial coverage and neoatherosclerosis are frequently observed in lesions with PSS .…”

“…These studies did not show the solution if we found PSS accidentally. Some studies concluded that continuation of dual antiplatelet therapy (DAPT) seemed not to be an effective treatment to prevent VLST . Although an effective treatment was important, risk stratification of PSS was also important to prevent cardiac adverse events.…”

“…In the first‐generation DES era, PSS might cause in‐stent restenosis and VLST . In the second‐generation DES era, the incidence of PSS after everolimus‐eluting stent (EES) implantation is less than after SES implantation .…”

Stent Fracture and Peri-Stent Contrast Staining After Everolimus-Eluting Stent Implantation ― 5-Year Outcomes ―

“…17 In the j-Cypher registry investigating 7,838 lesions with SES implantation, the cumulative rate of TLR was significantly higher in lesions with PSS than in those without PSS; however, that of TLR for restenosis (excluding the procedure for ST) was not significantly different between lesions with and without PSS. 15 In the present study, the cumulative rate of TLR was not significantly different between the PSS and non-PSS groups, possibly because of the low rate of ST.…”