Daisuke Nakamura1, Guilherme F Attizzani2, Catalin Toma1, Tej Sheth1, Wei Wang1, Mohamad Soud1, Reem Aoun1, Ramyashree Tummala1, Milana Leygerman1, Anas Fares1, Emile Mehanna1, Setsu Nishino1, Anthony Fung1, Marco A Costa1, Hiram G Bezerra1. 1. From the Cardiovascular Imaging Core Laboratory, Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Cleveland, OH (D.N., G.F.A., W.W., M.S., R.A., R.T., M.L., A.F., E.M., S.N., M.A.C., H.G.B.); Heart and Vascular Institute, University of Pittsburgh Medical Center, PA (C.T.); McMaster University and Population Health Research Institute, Hamilton Health Sciences, Ontario, Canada (T.S.); Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson (W.W.); and Division of Cardiology, Vancouver General Hospital, University of British Columbia, Canada (A.F.). 2. From the Cardiovascular Imaging Core Laboratory, Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Cleveland, OH (D.N., G.F.A., W.W., M.S., R.A., R.T., M.L., A.F., E.M., S.N., M.A.C., H.G.B.); Heart and Vascular Institute, University of Pittsburgh Medical Center, PA (C.T.); McMaster University and Population Health Research Institute, Hamilton Health Sciences, Ontario, Canada (T.S.); Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson (W.W.); and Division of Cardiology, Vancouver General Hospital, University of British Columbia, Canada (A.F.). guilherme.attizzani@uhhospitals.org.
Abstract
BACKGROUND: There are few clinical studies on the pathophysiological mechanisms of very late stent thrombosis (VLST). We report optical coherence tomography findings in patients with VLST and compare the findings between bare-metal stents (BMS) and drug-eluting stents (DES). METHODS AND RESULTS: We conducted a registry of stent thrombosis at 4 North American centers with optical coherence tomography imaging programs SAFE registry (The Study of Late Stent Failure Evaluated by OCT). Images were acquired in 61 patients (42 DES and 19 BMS) presenting with definite VLST. The median duration from implantation to VLST presentation was 51.4 months in the DES and 69.9 months in the BMS group (P=0.011). Uncovered and malapposed struts were observed in 70.5% (43/61) and 62.3% (38/61) of patients, respectively, whereas neoatherosclerosis was revealed in 49.2% (30/61). Stent underexpansion was observed in 42.4% of patients. Malapposed struts and stent underexpansion were more frequently demonstrated in DES than in BMS patients, whereas neoatherosclerosis was frequently observed in BMS (40.5% in DES and 68.4% in BMS; P=0.056). The percentage of frames with neoatherosclerosis was lower in DES than in BMS (15.56% [12.24-28.57] versus, 56.41% [40.74-70.00], respectively; P<0.001). Maximum consecutive lipid neointima length was shorter in DES than in BMS (2.4 [1.2-3.6] and 5.3 [3.0-7.0] mm; P=0.011). CONCLUSIONS: Optical coherence tomography imaging demonstrated that VLST in DES and BMS had a wide variety of abnormal findings, such as neoatherosclerosis, uncovered strut, and malapposed strut. Neoatherosclerosis and lipid neointima were more frequently observed and had more longitudinal extension in BMS compared with DES.
BACKGROUND: There are few clinical studies on the pathophysiological mechanisms of very late stent thrombosis (VLST). We report optical coherence tomography findings in patients with VLST and compare the findings between bare-metal stents (BMS) and drug-eluting stents (DES). METHODS AND RESULTS: We conducted a registry of stent thrombosis at 4 North American centers with optical coherence tomography imaging programs SAFE registry (The Study of Late Stent Failure Evaluated by OCT). Images were acquired in 61 patients (42 DES and 19 BMS) presenting with definite VLST. The median duration from implantation to VLST presentation was 51.4 months in the DES and 69.9 months in the BMS group (P=0.011). Uncovered and malapposed struts were observed in 70.5% (43/61) and 62.3% (38/61) of patients, respectively, whereas neoatherosclerosis was revealed in 49.2% (30/61). Stent underexpansion was observed in 42.4% of patients. Malapposed struts and stent underexpansion were more frequently demonstrated in DES than in BMS patients, whereas neoatherosclerosis was frequently observed in BMS (40.5% in DES and 68.4% in BMS; P=0.056). The percentage of frames with neoatherosclerosis was lower in DES than in BMS (15.56% [12.24-28.57] versus, 56.41% [40.74-70.00], respectively; P<0.001). Maximum consecutive lipid neointima length was shorter in DES than in BMS (2.4 [1.2-3.6] and 5.3 [3.0-7.0] mm; P=0.011). CONCLUSIONS: Optical coherence tomography imaging demonstrated that VLST in DES and BMS had a wide variety of abnormal findings, such as neoatherosclerosis, uncovered strut, and malapposed strut. Neoatherosclerosis and lipid neointima were more frequently observed and had more longitudinal extension in BMS compared with DES.
Authors: Gabriel T R Pereira; Alessio La Manna; Yasuhiro Ichibori; Armando Vergara-Martel; Bruno Ramos Nascimento; Abdul Jawwad Samdani; Davide Capodanno; Guido D'Agosta; Giacomo Gravina; Giuseppe Venuti; Corrado Tamburino; Guilherme F Attizzani Journal: Int J Cardiovasc Imaging Date: 2019-06-07 Impact factor: 2.357
Authors: Elisabetta Moscarella; Alfonso Ielasi; Maria Carmen De Angelis; Fortunato Scotto di Uccio; Enrico Cerrato; Roberta De Rosa; Gianluca Campo; Attilio Varricchio Journal: J Thorac Dis Date: 2017-08 Impact factor: 2.895
Authors: Annunziata Nusca; Michele Mattia Viscusi; Francesco Piccirillo; Aurelio De Filippis; Antonio Nenna; Cristiano Spadaccio; Francesco Nappi; Camilla Chello; Fabio Mangiacapra; Francesco Grigioni; Massimo Chello; Gian Paolo Ussia Journal: Life (Basel) Date: 2022-03-08