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Characteristics of Earlier Versus Delayed Presentation of Very Late Drug-Eluting Stent Thrombosis: An Optical Coherence Tomographic Study.

Authors
 Seung‐Yul Lee  ;  Jung‐Min Ahn  ;  Gary S. Mintz  ;  Seung‐Ho Hur  ;  So‐Yeon Choi  ;  Sang‐Wook Kim  ;  Jin Man Cho  ;  Soon Jun Hong  ;  Jin Won Kim  ;  Young Joon Hong  ;  Sang‐Gon Lee  ;  Dong‐Ho Shin  ;  Jung‐Sun Kim  ;  Byeong‐Keuk Kim  ;  Young‐Guk Ko  ;  Donghoon Choi  ;  Yangsoo Jang  ;  Seung‐Jung Park  ;  Myeong‐Ki Hong 
Citation
 JOURNAL OF THE AMERICAN HEART ASSOCIATION, Vol.6(4) : 005386, 2017 
Journal Title
 JOURNAL OF THE AMERICAN HEART ASSOCIATION 
Issue Date
2017
MeSH
Aged ; Coronary Artery Disease/diagnostic imaging ; Coronary Artery Disease/therapy* ; Coronary Thrombosis/diagnostic imaging* ; Coronary Thrombosis/etiology ; Coronary Vessels/diagnostic imaging* ; Drug-Eluting Stents* ; Female ; Humans ; Male ; Middle Aged ; Neointima ; Percutaneous Coronary Intervention/adverse effects* ; Percutaneous Coronary Intervention/instrumentation* ; Plaque, Atherosclerotic ; Predictive Value of Tests ; Retrospective Studies ; Time Factors ; Tomography, Optical Coherence* ; Treatment Outcome
Keywords
coronary artery disease ; drug‐eluting stent ; optical coherence tomography
Abstract
BACKGROUND: The pathophysiology underlying very late drug-eluting stent (DES) thrombosis is not sufficiently understood. Using optical coherence tomography, we investigated characteristics of very late stent thrombosis (VLST) according to different onset times. METHODS AND RESULTS: A total of 98 patients from 10 South Korean hospitals who underwent optical coherence tomography for evaluation of very late DES thrombosis were retrospectively included in analyses. VLST occurred at a median of 55.1 months after DES implantation. All patients were divided into 2 equal groups of earlier versus delayed presentation of VLST, according to median onset time. In total, 27 patients were treated with next-generation DES and 71 with first-generation DES. Based on optical coherence tomography findings at thrombotic sites, main VLST mechanisms were as follows, in descending order: neoatherosclerosis (34.7%), stent malapposition (33.7%), and uncovered struts without stent malapposition or evagination (24.5%). Compared with patients with earlier VLST, patients with delayed VLST had lower frequency of uncovered struts without stent malapposition or evagination (34.7% versus 14.3%, respectively; P=0.019). Conversely, the frequency of neoatherosclerosis was higher in patients with delayed versus earlier VLST (44.9% versus 24.5%, respectively; P=0.034). The frequency of stent malapposition was not different between patients with earlier and delayed VLST (34.7% versus 32.7%, respectively; P=0.831). The frequency of stent malapposition, evagination, and uncovered struts was still half of delayed VLST. CONCLUSIONS: The pathological mechanisms of very late DES thrombosis changed over time. Delayed neointimal healing remained a substantial substrate for VLST, even long after DES implantation.
Full Text
http://jaha.ahajournals.org/content/6/4/e005386.long
DOI
10.1161/JAHA.116.005386.
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Ko, Young Guk(고영국) ORCID logo https://orcid.org/0000-0001-7748-5788
Kim, Byeong Keuk(김병극) ORCID logo https://orcid.org/0000-0003-2493-066X
Kim, Jung Sun(김중선) ORCID logo https://orcid.org/0000-0003-2263-3274
Shin, Dong Ho(신동호) ORCID logo https://orcid.org/0000-0002-7874-5542
Jang, Yang Soo(장양수) ORCID logo https://orcid.org/0000-0002-2169-3112
Choi, Dong Hoon(최동훈) ORCID logo https://orcid.org/0000-0002-2009-9760
Hong, Myeong Ki(홍명기) ORCID logo https://orcid.org/0000-0002-2090-2031
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/154571
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