Stent underexpansion and residual reference segment stenosis are related to stent thrombosis after sirolimus-eluting stent implantation

Fujii, Kenichi; Carlier, Stéphane; Mintz, Gary S.; Yang, Yufei; Moussa, Issam; Weisz, Giora; Dangas, George; Mehran, Roxana; Lansky, Alexandra J.; Kreps, Edward M.; Collins, Michael B.; Stone, Gregg W.; Moses, Jeffrey W.; Leon, Martin B.

doi:10.1016/j.jacc.2004.12.066

Cited by 696 publications

(142 citation statements)

References 15 publications

Supporting

Mentioning

127

Contrasting

Order By: Relevance

“…Previous reports showed that stent thrombosis may be associated with stent underexpansion,28, 29 smaller lumens, and more dissections,28, 30 but not with ASM28, 29 or tissue protrusion 28. In the current study, the final minimum stent area measured 6.3 (6.2–6.3) mm 2 (least‐squares means, 95% CI) and was numerically larger in lesions with ASM with few stents meeting standard criteria for underexpansion.…”

Section: Discussionsupporting

confidence: 43%

Predictors and Long‐Term Clinical Impact of Acute Stent Malapposition: An Assessment of Dual Antiplatelet Therapy With Drug‐Eluting Stents (ADAPT‐DES) Intravascular Ultrasound Substudy

Wang

Mintz

Witzenbichler

et al. 2016

JAHA

Self Cite

View full text Add to dashboard Cite

BackgroundThe impact of acute stent malapposition (ASM) on long‐term clinical outcomes in patients undergoing percutaneous coronary intervention is still controversial. We sought to evaluate predictors and long‐term clinical outcomes of ASM.Methods and Results ADAPT‐DES (Assessment of Dual Antiplatelet Therapy With Drug‐Eluting Stents) was a prospective multicenter study of 8663 patients undergoing percutaneous coronary intervention using drug‐eluting stents. In a prespecified intravascular ultrasound–guided substudy, 2072 patients with 2446 culprit lesions had post–percutaneous coronary intervention intravascular ultrasound and were classified according to the presence or absence of ASM. After intravascular ultrasound–guided percutaneous coronary intervention, the overall prevalence of ASM after successful drug‐eluting stents implantation was 14.4% per patient and 12.6% per lesion. Compared to lesions without ASM, lesions with ASM had larger in‐stent lumen areas, larger stent areas, and larger in‐stent vessel areas. A larger mean plaque area along with more attenuated plaque was observed in lesions with ASM versus lesions without ASM. Lesions with ASM had greater proximal and distal reference lumen areas and more distal, but not proximal, reference calcium compared to lesions without ASM. At 2‐year follow‐up, there was no significant difference in the incidence of cardiac death; myocardial infarction; early, late, or very late stent thrombosis; or clinically driven target lesion revascularization in patients with ASM versus those without ASM. Furthermore, ASM was not an independent predictor of 2‐year major adverse cardiac events or target lesion revascularization even when forced into the multivariate model.ConclusionsIn patients treated with intravascular ultrasound–guided drug‐eluting stents implantation, ASM was not associated with adverse clinical events during long‐term follow‐up including, but not limited to, stent thrombosis.Clinical Trial Registration URL: https://www.clinicaltrials.gov. Unique identifier: NCT00638794.

show abstract

Section: Discussionsupporting

confidence: 43%

Predictors and Long‐Term Clinical Impact of Acute Stent Malapposition: An Assessment of Dual Antiplatelet Therapy With Drug‐Eluting Stents (ADAPT‐DES) Intravascular Ultrasound Substudy

Wang

Mintz

Witzenbichler

et al. 2016

JAHA

Self Cite

View full text Add to dashboard Cite

show abstract

“…days) ST after bare metal stent (BMS) 9 and DES implantation 10 found stent underexpansion and residual stenoses as predisposing factors. However, no study examined structural differences in stented vessel segments in patients with very late ST (Ͼ1 year) after DES implantation.…”

Section: Editorial P 2379 Clinical Perspective P 2434mentioning

confidence: 99%

“…9,13 In a recent study of 21 patients with documented SES thrombosis occurring an average of 14 days after the index procedure, Fujii and colleagues 10 identified stent underexpansion and a residual reference segment stenosis as predictors of early ST. In the present study, 4 very late ST patients also had evidence of stent underexpansion, which was related to severely calcified lesions with a calcium arc of 360°.…”

Section: Other Ultrasonic Predictors Of Stmentioning

confidence: 99%

Incomplete Stent Apposition and Very Late Stent Thrombosis After Drug-Eluting Stent Implantation

et al. 2007

View full text Add to dashboard Cite

Background— Stent thrombosis may occur late after drug-eluting stent (DES) implantation, and its cause remains unknown. The present study investigated differences of the stented segment between patients with and without very late stent thrombosis with the use of intravascular ultrasound. Methods and Results— Since January 2004, patients presenting with very late stent thrombosis (>1 year) after DES implantation underwent intravascular ultrasound. Findings in patients with very late stent thrombosis were compared with intravascular ultrasound routinely obtained 8 months after DES implantation in 144 control patients, who did not experience stent thrombosis for ≥2 years. Very late stent thrombosis was encountered in 13 patients at a mean of 630±166 days after DES implantation. Compared with DES controls, patients with very late stent thrombosis had longer lesions (23.9±16.0 versus 13.3±7.9 mm; P <0.001) and stents (34.6±22.4 versus 18.6±9.5 mm; P <0.001), more stents per lesion (1.6±0.9 versus 1.1±0.4; P <0.001), and stent overlap (39% versus 8%; P <0.001). Vessel cross-sectional area was similar for the reference segment (cross-sectional area of the external elastic membrane: 18.9±6.9 versus 20.4±7.2 mm 2 ; P =0.46) but significantly larger for the in-stent segment (28.6±11.9 versus 20.1±6.7 mm 2 ; P =0.03) in very late stent thrombosis patients compared with DES controls. Incomplete stent apposition was more frequent (77% versus 12%; P <0.001) and maximal incomplete stent apposition area was larger (8.3±7.5 versus 4.0±3.8 mm 2 ; P =0.03) in patients with very late stent thrombosis compared with controls. Conclusions— Incomplete stent apposition is highly prevalent in patients with very late stent thrombosis after DES implantation, suggesting a role in the pathogenesis of this adverse event.

show abstract

“…34,35 Intravascular ultrasound in 15 patients with ST compared with 45 control subjects revealed smaller minimal stent area (4.3Ϯ1.6 versus 6.2Ϯ1.9 mm 2 ; PϽ0.001), reduced stent expansion (65Ϯ18% versus 85Ϯ14%; PϽ0.001), and residual edge stenosis (67% versus 9%; PϽ0.001) to be more common in the ST patients than the control subjects. 56 …”

Section: Risk Factors Of Stmentioning

confidence: 99%

Late Coronary Stent Thrombosis

2007

View full text Add to dashboard Cite

Introduced Ͼ20 years ago, 1 coronary artery stents have improved the safety and particularly the efficacy of percutaneous coronary interventions (PCIs). 2 Abrupt vessel closure, complicating 6% to 8% of balloon angioplasty procedures, was associated with a 5% mortality, 40% rate of myocardial infarction (MI), and 40% rate of emergency coronary artery bypass grafting. 3 Stents significantly reduced these adverse events (Figure 1). 4,5 The reduction of restenosis afforded by bare metal stents (BMS) was modest (30% to 40%). Repeat revascularization still occurred in 15% to 20% of cases. 6 Drug-eluting stents (DES) with antiproliferative drugs attached via polymers on the stent surface to minimize smooth muscle proliferation have reduced restenosis and rates of target lesion revascularization by 50% to 70% compared with BMS across nearly all lesion and patient subsets. 7 Initially 8 and again more recently, 9 -16 safety concerns were raised about DES, particularly about late stent thrombosis (ST). Historical PerspectiveST was a bane of stent implantation from the beginning. The initial experience with Wallstents in the late 1980s was overshadowed by ST rates approaching 24%. 17 Subsequent series with Palmaz-Schatz and Gianturco-Roubin stents (still predominantly bailout stenting) observed ST in 6% to 12% of cases. 4,18 The postprocedural antithrombotic regimen at the time consisted of aspirin, often in conjunction with oral anticoagulation. Dual antiplatelet therapy of aspirin and the thienopyridine ticlopidine in conjunction with a shift from bailout to elective stenting resulted in a significant reduction of ST to Ͻ2%. 5,19 Earlier oral antiplatelet drug loading and glycoprotein IIb/IIIa antagonists further diminished ST. Table 1 provides an overview of ST reported in contemporary trials of BMS and DES, ranging from 0.1% to 3.1%. 11,20 -38 The wide range in the incidence of ST across trials with both BMS and DES is explained by differences in definitions, length of follow-up, antithrombotic drug regimens, and complexity of patients and lesions.

show abstract

Stent underexpansion and residual reference segment stenosis are related to stent thrombosis after sirolimus-eluting stent implantation

Abstract: Stent underexpansion and residual reference segment stenosis are associated with stent thrombosis after successful SES implantation.

Cited by 696 publications

References 15 publications

Predictors and Long‐Term Clinical Impact of Acute Stent Malapposition: An Assessment of Dual Antiplatelet Therapy With Drug‐Eluting Stents (ADAPT‐DES) Intravascular Ultrasound Substudy

Predictors and Long‐Term Clinical Impact of Acute Stent Malapposition: An Assessment of Dual Antiplatelet Therapy With Drug‐Eluting Stents (ADAPT‐DES) Intravascular Ultrasound Substudy

Incomplete Stent Apposition and Very Late Stent Thrombosis After Drug-Eluting Stent Implantation

Late Coronary Stent Thrombosis

Contact Info

Product

Resources

About