IVUS-guided treatment strategies for definite late and very late stent thrombosis

Gomez‐Lara, Josep; Salvatella, Neus; Gonzalo, Nieves; Hernández-Hernández, Felipe; Fernández-Nofrerias, Eduard; Sánchez‐Recalde, Ángel; Bastante, Teresa; Marcano, Ana Lucrecia; Romaguera, Rafael; Ferreiro, José Luis; Roura, Gerard; Teruel, Luís; Arizá-Solé, Albert; Miranda-Guardiola, Faustino; García-Abad, Vera Rodríguez; Gómez‐Hospital, Joan Antoni; Alfonso, Fernándo; Cequier, Ángel

doi:10.4244/eijy15m12_08

Cited by 15 publications

(1 citation statement)

References 25 publications

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“…7,8 It is also remarkable that stents implanted in the setting of STEMI had larger number of uncovered and malapposed struts and had higher rate of late ST than stents implanted in other clinical settings. [9][10][11] The main objective of the study is to compare the number of lesions with at least one cross-section with RUTSS ≥30% between EES and BMS in STEMI patients, as assessed by OCT, at 5-year follow-up. This study also aims to compare other OCT findings associated with the occurrence of late ST such as the presence of stent malapposition and neoatherosclerotic plaques between EES and BMS.…”

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confidence: 99%

Five-Year Optical Coherence Tomography in Patients With ST-Segment–Elevation Myocardial Infarction Treated With Bare-Metal Versus Everolimus-Eluting Stents

Gomez‐Lara

Brugaletta

Jacobi

et al. 2016

Circ: Cardiovascular Interventions

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P ercutaneous coronary intervention with stent implantation is the standard of care in patients with ST-segmentelevation myocardial infarction (STEMI). 1 Patients treated with first-generation drug-eluting stents (DES) had lower rate of target lesion revascularization than patients treated with bare-metal stents (BMS) at 5 years.2 However, this reduction was only observed during the first year after stent implantation. The analysis of the subsequent years (from 1-5 years) showed higher rate of target lesion revascularization in the group treated with first-generation DES than in the group treated with BMS. This was caused by a higher incidence of very-late stent thrombosis (ST) in the group treated with firstgeneration DES.2 Moreover, it is also remarkable that the incidence of late ST has no attenuation neither with DES nor with BMS at very long-term follow-up (>5 years).

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confidence: 99%

Five-Year Optical Coherence Tomography in Patients With ST-Segment–Elevation Myocardial Infarction Treated With Bare-Metal Versus Everolimus-Eluting Stents

Gomez‐Lara

Brugaletta

Jacobi

et al. 2016

Circ: Cardiovascular Interventions

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Introduction to Multimodality Intravascular Imaging

Chen

Zhou

2019

Multimodality Imaging

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One-year optical coherence tomography findings in patients with late and very-late stent thrombosis treated with intravascular imaging guided percutaneous coronary intervention

Ñato

Gomez‐Lara

Romaguera

et al. 2018

Int J Cardiovasc Imaging

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Patients with late/very-late stent thrombosis (ST) are at high risk of recurrent-ST. The mechanisms of recurrent-ST are largely unknown. The objective is to describe the 1-year optical coherence tomography (OCT) findings of patients suffering from late/very-late ST treated with intravascular imaging guided percutaneous coronary intervention (PCI). All consecutive patients with late/very-late ST undergoing intravascular imaging guided PCI were screened to undergo coronary angiography and OCT examination at 1 year. Patients were classified according to the observation of stent malapposition as most contributing cause of the ST. Thirty-four patients were included. Stent malapposition was observed in 17 (50%) and the remaining 17 cases were classified as: neoatherosclerosis (n = 9), underexpansion (n = 3) and unknown mechanism (n = 5). Patients with malapposition had a remarkable reduction of the malapposition volume (from 6.4 to 1.3 mm; p = 0.02) during the ST procedure, but this was not fully corrected in 13 (76.5%). At 12 months, two patients of the malapposition group presented with uneventful target vessel re-occlusion. Persistent malapposition was observed in nine patients (60.0%). Major coronary evaginations (46.7 vs. 0%; p = 0.001) and uncovered struts (6.3 vs. 1.0%; p < 0.001) were also more frequent in patients with malapposition than without malapposition. None of the patients had thin-cap fibroatheroma neoatherosclerosis. Contributing causes of late/very-late ST are diverse and have different healing patterns at 12 months. Patients with stent malapposition treated with intravascular imaging guided PCI showed poor re-healing; but patients with other causes of the ST showed optimal stent healing as assessed by OCT.

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IVUS-guided treatment strategies for definite late and very late stent thrombosis

Abstract: Non-optimal IVUS criteria of stent implantation are often observed in patients with late ST. Treatment of late ST with BA leads to a larger reduction of malapposition and underexpansion with respect to ASI and is associated with favourable outcomes.

Cited by 15 publications

References 25 publications

Five-Year Optical Coherence Tomography in Patients With ST-Segment–Elevation Myocardial Infarction Treated With Bare-Metal Versus Everolimus-Eluting Stents

Five-Year Optical Coherence Tomography in Patients With ST-Segment–Elevation Myocardial Infarction Treated With Bare-Metal Versus Everolimus-Eluting Stents

Introduction to Multimodality Intravascular Imaging

One-year optical coherence tomography findings in patients with late and very-late stent thrombosis treated with intravascular imaging guided percutaneous coronary intervention

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