Lara Fuentes1, Josep Gómez-Lara2, Neus Salvatella3, Nieves Gonzalo4, Felipe Hernández-Hernández5, Eduard Fernández-Nofrerias6, Ángel Sánchez-Recalde7, Fernando Alfonso8, Rafael Romaguera2, José Luis Ferreiro2, Gerard Roura2, Luis Teruel2, Montserrat Gracida2, Ana Lucrecia Marcano2, Joan-Antoni Gómez-Hospital2, Ángel Cequier2. 1. Departamento de Cardiología Intervencionista, Hospital Universitari de Bellvitge, Institut d' Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain. Electronic address: castillo@gmail.com. 2. Departamento de Cardiología Intervencionista, Hospital Universitari de Bellvitge, Institut d' Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain. 3. Departamento de Cardiología Intervencionista, Hospital del Mar, Barcelona, Spain. 4. Departamento de Cardiología Intervencionista, Hospital Clínico San Carlos, Madrid, Spain. 5. Departamento de Cardiología Intervencionista, Hospital 12 de Octubre, Madrid, Spain. 6. Departamento de Cardiología Intervencionista, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain. 7. Departamento de Cardiología Intervencionista, Hospital La Paz, Madrid, Spain. 8. Departamento de Cardiología Intervencionista, Hospital de La Princesa, Madrid, Spain.
Abstract
INTRODUCTION AND OBJECTIVES: Stent thrombosis (ST) is a life-threatening complication after stent implantation. Intravascular ultrasound is able to discern most causes of ST. The aim of this study was to compare intravascular ultrasound findings between bare-metal stents (BMS) and drug-eluting stents (DES) in patients with late (31 days to 1 year) or very late ST (> 1 year). METHODS: Of 250 consecutive patients with late or very late ST in 7 Spanish institutions, 114 patients (45.5% BMS and 54.5% DES) were imaged with intravascular ultrasound. Off-line intravascular ultrasound analysis was performed to assess malapposition, underexpansion, and neoatherosclerosis. RESULTS: The median time from stent implantation to ST was 4.0 years with BMS and 3.4 years with DES (P = .04). Isolated malapposition was similarly observed in both groups (36.5% vs 46.8%; P = .18) but was numerically lower with BMS (26.6% vs 48.0%; P = .07) in patients with very late ST. Isolated underexpansion was similarly observed in both groups (13.5% vs 11.3%; P = .47). Isolated neoatherosclerosis occurred only in patients with very late ST and was more prevalent with BMS (22.9%) than with DES (6.0%); P = .02. At 2.9 years' follow-up, there were 0% and 6.9% cardiac deaths, respectively (P = .06) and recurrent ST occurred in 4.0% and 5.2% of patients, respectively (P = .60). CONCLUSIONS: Malapposition was the most common finding in patients with late and very late ST and is more prevalent with DES in very late ST. In contrast, neoatherosclerosis was exclusively observed in patients with very late ST and mainly with BMS.
INTRODUCTION AND OBJECTIVES: Stent thrombosis (ST) is a life-threatening complication after stent implantation. Intravascular ultrasound is able to discern most causes of ST. The aim of this study was to compare intravascular ultrasound findings between bare-metal stents (BMS) and drug-eluting stents (DES) in patients with late (31 days to 1 year) or very late ST (> 1 year). METHODS: Of 250 consecutive patients with late or very late ST in 7 Spanish institutions, 114 patients (45.5% BMS and 54.5% DES) were imaged with intravascular ultrasound. Off-line intravascular ultrasound analysis was performed to assess malapposition, underexpansion, and neoatherosclerosis. RESULTS: The median time from stent implantation to ST was 4.0 years with BMS and 3.4 years with DES (P = .04). Isolated malapposition was similarly observed in both groups (36.5% vs 46.8%; P = .18) but was numerically lower with BMS (26.6% vs 48.0%; P = .07) in patients with very late ST. Isolated underexpansion was similarly observed in both groups (13.5% vs 11.3%; P = .47). Isolated neoatherosclerosis occurred only in patients with very late ST and was more prevalent with BMS (22.9%) than with DES (6.0%); P = .02. At 2.9 years' follow-up, there were 0% and 6.9% cardiac deaths, respectively (P = .06) and recurrent ST occurred in 4.0% and 5.2% of patients, respectively (P = .60). CONCLUSIONS: Malapposition was the most common finding in patients with late and very late ST and is more prevalent with DES in very late ST. In contrast, neoatherosclerosis was exclusively observed in patients with very late ST and mainly with BMS.
Authors: Nicolas W Shammas; Qais Radaideh; W John Shammas; Ghassan E Daher; Rayan Jo Rachwan; Yazan Radaideh Journal: Vasc Health Risk Manag Date: 2019-08-07