Intravascular Ultrasound Findings of Early Stent Thrombosis After Primary Percutaneous Intervention in Acute Myocardial Infarction

Abstract

Background-Small stent area and residual inflow/outflow disease have been reported as the strongest intravascular ultrasound (IVUS) predictors of early stent thrombosis (ST) in patients with stable angina. IVUS predictors of early ST in patients with acute myocardial infarction have not been studied. Methods and Results-In the Harmonizing Outcomes with Revascularization and Stents in Acute MyocardialInfarction (HORIZONS-AMI) study, a formal substudy included poststent and 13-month follow-up IVUS at 36 centers. Twelve patients with baseline IVUS who had definite/probable early ST Յ30 days after enrollment were compared with 389 patients without early ST. Significant residual stenosis was a lumen area Ͻ4.0 mm 2 with Ն70% plaque burden Յ10 mm from each stent edge. Significant edge dissection was more than medial dissection with lumen area Ͻ4 mm 2 or dissection angle Ն60°. Randomization to bivalirudin (Pϭ0.29) or paclitaxel-eluting stent (Pϭ0.74) was not related to early ST. Minimum lumen area was smaller in patients with versus without early ST (4.4 mm 2 [3.6, 6.9] versus 6.7 mm 2 [5.3, 8.0], respectively, Pϭ0.014). Minimum lumen area Ͻ5 mm 2 , significant residual stenosis, significant stent edge dissection, and significant tissue (plaque/thrombus) protrusion (more than the median that narrowed the lumen to Ͻ4 mm 2 ) were more prevalent in patients with early ST, but significant acute malapposition (more than the median) was not. Overall, 100% of patients with early ST had at least 1 of these significant features: minimum lumen area Ͻ5 mm 2 , edge dissection, residual stenosis, or tissue protrusion versus 23% in patients without early ST (PϽ0.01). Conclusions-Smaller

Optical Coherence Tomography to Optimize Results of Percutaneous Coronary Intervention in Patients with Non–ST-Elevation Acute Coronary Syndrome

“…21 Conversely, deeper dissections may be associated with an increased risk of target lesion revascularization and type 4a MI, as suggested by literature data. 3,5,24,25 Tissue prolapse was also observed at a very high rate in our study. The prognostic impact of changing the procedural strategy in response to prolapse remains unclear, although there is some evidence to suggest that prolapse may have a deleterious impact.…”

StentBoost Visualization for the Evaluation of Coronary Stent Expansion During Percutaneous Coronary Interventions

“…Procedural parameters such as total stent length and the degree of stent expansion have been associated with increased risk of restenosis and thrombosis following PCI [7, 8]. A number of studies have proposed different IVUS cutoffs (i.e., minimal stent cross-sectional area or diameter), which in turn have predicted repeat revascularizations after drug-eluting stent DES and bare-metal stent deployment [4, 15, 16].…”

Heterogeneous Intravascular Ultrasound Findings of Stent Thrombosis

“…Persistent dissections and slow flow, thrombus, stent underexpansion, tissue prolapse, and residual stenosis have been suggested as procedure-related contributing factors to stent thrombosis (27-30). Of these factors, we experienced persistent dissection and stent underexpansion.…”

“…Although coronary dissection after percutaneous coronary intervention is not a rare complication, its detection and precise evaluation have an impact in a clinical setting, as it has been reported that coronary dissections are associated with adverse cardiovascular events (30,31). A pathological study suggested that exposure of connective tissue to blood speckle in the lumen due to dissection may result in the progression of thrombus formation (32).…”