Geraud Souteyrand1, Nicolas Amabile2, Lionel Mangin3, Xavier Chabin4, Nicolas Meneveau5, Guillaume Cayla6, Gerald Vanzetto7, Pierre Barnay8, Charlotte Trouillet9, Gilles Rioufol10, Gregoire Rangé11, Emmanuel Teiger12, Regis Delaunay13, Olivier Dubreuil14, Thibault Lhermusier15, Aurélien Mulliez16, Sebastien Levesque17, Loic Belle3, Christophe Caussin2, Pascal Motreff4. 1. Cardiology Department, CHU Clermont-Ferrand, Clermont-Ferrand 63000, France Cardio Vascular Interventional Therapy and Imaging (CaVITI), UMR CNRS 6284, Auvergne University, Clermont-Ferrand, France gsouteyrand@chu-clermontferrand.fr. 2. Cardiology Department, Institut Mutualiste Montsouris, Paris, France. 3. Cardiology Department, CH Annecy, Annecy, France. 4. Cardiology Department, CHU Clermont-Ferrand, Clermont-Ferrand 63000, France Cardio Vascular Interventional Therapy and Imaging (CaVITI), UMR CNRS 6284, Auvergne University, Clermont-Ferrand, France. 5. Cardiology Department, CHU Besançon, Besançon, France. 6. Cardiology Department, CHU Nimes, Nimes, France. 7. Cardiology Department, CHU Grenoble, Grenoble, France. 8. Cardiology Department, CH Henri Duffaut, Avignon, France. 9. Cardiology Department, CH La Rochelle-Re-Aunis, La Rochelle, France. 10. Cardiology Department, Hospices Civils de Lyon, Bron, France. 11. Cardiology Department, CH Chartres, Chartres, France. 12. Cardiology Department, CHU Henri Mondor-Assistance Publique-Hôpitaux de Paris, Creteil, France. 13. Cardiology Department, CH St Brieuc, St Brieuc, France. 14. Cardiology Department, St Luc-St Joseph hospital, Lyon, France. 15. Department of Cardiology, CHU Rangueil, Toulouse, France. 16. Bio-Statistics Unit, délégation recherche clinique & innovation, CHU de Clermont-Ferrand, France. 17. Cardiology Department, CHU Poitiers, Poitiers, France.
Abstract
AIMS: Angiography has limited value for identifying the causes of stent thrombosis (ST). We studied a large cohort of patients by optical coherence tomography (OCT) to explore ST characteristics and mechanisms. METHODS AND RESULTS: A prospective multicentre registry was screened for patients with confirmed ST. Optical coherence tomography was performed after initial intervention to the culprit lesion (in 69% of cases in a deferred procedure). Stent thrombosis was classified as acute (AST), sub-acute (SAST), late (LST), and very late (VLST). Optical coherence tomography records were analysed in a central core lab. The analysis included 120 subjects aged 61.7 [51.4-70.7]; 89% male. Very late ST was the clinical presentation in 75%, LST in 6%, SAST in 15%, and AST in 4% of patients. Bare metal stents (BMS) were used in 39%, drug-eluting stents (DES) in 59% and bioresorbable vascular scaffolds in 2% of the cases. Optical coherence tomography identified an underlying morphological abnormality in 97% of cases, including struts malapposition (34%), neoatherosclerotic lesions (22%), major stent underexpansion (11%), coronary evagination (8%), isolated uncovered struts (8%), edge-related disease progression (8%), and neointimal hyperplasia (4%). Ruptured neoatherosclerotic lesions were more frequent with BMS than with DES (36 vs. 14%, P = 0.005), whereas coronary evaginations were more frequent with DES than with BMS (12 vs. 2%, P = 0.04). LST + VLST were mainly related to malapposition (31%) and neoatherosclerosis (28%), while prominent mechanisms for AST + SAST were malapposition (48%) and underexpansion (26%). CONCLUSION: In patients with confirmed ST, OCT imaging identified an underlying morphological abnormality in 97% of cases. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: Angiography has limited value for identifying the causes of stent thrombosis (ST). We studied a large cohort of patients by optical coherence tomography (OCT) to explore ST characteristics and mechanisms. METHODS AND RESULTS: A prospective multicentre registry was screened for patients with confirmed ST. Optical coherence tomography was performed after initial intervention to the culprit lesion (in 69% of cases in a deferred procedure). Stent thrombosis was classified as acute (AST), sub-acute (SAST), late (LST), and very late (VLST). Optical coherence tomography records were analysed in a central core lab. The analysis included 120 subjects aged 61.7 [51.4-70.7]; 89% male. Very late ST was the clinical presentation in 75%, LST in 6%, SAST in 15%, and AST in 4% of patients. Bare metal stents (BMS) were used in 39%, drug-eluting stents (DES) in 59% and bioresorbable vascular scaffolds in 2% of the cases. Optical coherence tomography identified an underlying morphological abnormality in 97% of cases, including struts malapposition (34%), neoatherosclerotic lesions (22%), major stent underexpansion (11%), coronary evagination (8%), isolated uncovered struts (8%), edge-related disease progression (8%), and neointimal hyperplasia (4%). Ruptured neoatherosclerotic lesions were more frequent with BMS than with DES (36 vs. 14%, P = 0.005), whereas coronary evaginations were more frequent with DES than with BMS (12 vs. 2%, P = 0.04). LST + VLST were mainly related to malapposition (31%) and neoatherosclerosis (28%), while prominent mechanisms for AST + SAST were malapposition (48%) and underexpansion (26%). CONCLUSION: In patients with confirmed ST, OCT imaging identified an underlying morphological abnormality in 97% of cases. Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: Florian Blachutzik; Niklas Boeder; Jens Wiebe; Alessio Mattesini; Oliver Dörr; Astrid Most; Timm Bauer; Jens Röther; Monique Tröbs; Christian Schlundt; Stephan Achenbach; Christian W Hamm; Holger M Nef Journal: Clin Res Cardiol Date: 2016-10-18 Impact factor: 5.460