Very late stent thrombosis related to incomplete neointimal coverage or neoatherosclerotic plaque rupture identified by optical coherence tomography imaging

Abstract

Our data show that ISNA is frequent in patients with VLST. These results suggest that OCT imaging is helpful in identifying the underlying mechanisms of VLST and, therefore, in the clinical decision-making process.

Causes of Very Late Stent Thrombosis Investigated Using Optical Coherence Tomography

“…The authors proposed that ISNA should be recognized as the culprit lesion if the following criteria are fulfilled: (i) the presence of neoatherosclerotic tissue transformation within the stent; (ii) the presence of neointimal rupture within the stent; (iii) the absence of uncovered struts; and (iv) the absence of ruptured-cap atherosclerotic lesions proximal or distal to the stent (25). Therefore, they considered that uncovered struts were not simultaneously present with ISNA in VLST lesions.…”

Mechanisms of Very Late Drug-Eluting Stent Thrombosis Assessed by Optical Coherence Tomography

“…[6][7][8][9][10] Although autopsy studies suggest substantial differences in the vascular healing response between early-generation and new-generation DES, 11 in vivo investigation of mechanisms underlying VLST according to DES type is limited. Although histopathology and OCT have identified mechanical factors and focal stent abnormalities at the strut level, 6,8 the spatial pattern of these abnormalities in stented segments with compared with those without thrombosis has not been reported; such evidence could be meaningful for the purpose of optimizing stent deployment to prevent stent thrombosis and to guide therapeutic approaches at the time of VLST.…”

Characterization of coronary atherosclerosis by intravascular imaging modalities

“…In addition, earlier and more frequent development of neoatherosclerosis after DES implantation has been observed in pathohistological and clinical studies (58,59). Currently, neoatherosclerosis is considered as one of important mechanisms associated with late stent thrombosis and restenosis (54,57,60,61). OCT has a great potential to evaluate in-stent neoatherosclerosis in vivo.…”

“…OCT has a great potential to evaluate in-stent neoatherosclerosis in vivo. In-stent neoatherosclerosis by OCT imaging has been defined as the combination of neointimal diffuse thickening with intimal lipid-laden (poor signal region with diffuse borders) and the presence of fibrous cap (57,61,62). In a recent study analyzing in-stent restenosis lesions after DES implantation by OCT, TCFA and neointimal rupture within stent were observed in 52% and 58% of study …”