In Vivo Optical Coherence Tomography of Very Late Drug-Eluting Stent Thrombosis Compared With Late In-Stent Restenosis

Shinichiro Miyazaki; Yoshikazu Hiasa; Takefumi Takahashi; Yudai Yano; Tomoko Minami; Naotsugu Murakami; Michiko Mizobe; Yohei Tobetto; Takafumi Nakagawa; Po-Min Chen; Riyo Ogura; Hitoshi Miyajima; Kenichiro Yuba; Shinobu Hosokawa; Koichi Kishi; Ryuji Ohtani

doi:10.1253/circj.CJ-11-0961

Imaging

In Vivo Optical Coherence Tomography of Very Late Drug-Eluting Stent Thrombosis Compared With Late In-Stent Restenosis

Shinichiro Miyazaki, Yoshikazu Hiasa, Takefumi Takahashi, Yudai Yano, Tomoko Minami, Naotsugu Murakami, Michiko Mizobe, Yohei Tobetto, Takafumi Nakagawa, Po-Min Chen, Riyo Ogura, Hitoshi Miyajima, Kenichiro Yuba, Shinobu Hosokawa, Koichi Kishi, Ryuji Ohtani

Author information

Shinichiro Miyazaki
Department of Cardiology, Tokushima Red Cross Hospital
Yoshikazu Hiasa
Department of Cardiology, Tokushima Red Cross Hospital
Takefumi Takahashi
Department of Cardiology, Tokushima Red Cross Hospital
Yudai Yano
Department of Cardiology, Tokushima Red Cross Hospital
Tomoko Minami
Department of Cardiology, Tokushima Red Cross Hospital
Naotsugu Murakami
Department of Cardiology, Tokushima Red Cross Hospital
Michiko Mizobe
Department of Cardiology, Tokushima Red Cross Hospital
Yohei Tobetto
Department of Cardiology, Tokushima Red Cross Hospital
Takafumi Nakagawa
Department of Cardiology, Tokushima Red Cross Hospital
Po-Min Chen
Department of Cardiology, Tokushima Red Cross Hospital
Riyo Ogura
Department of Cardiology, Tokushima Red Cross Hospital
Hitoshi Miyajima
Department of Cardiology, Tokushima Red Cross Hospital
Kenichiro Yuba
Department of Cardiology, Tokushima Red Cross Hospital
Shinobu Hosokawa
Department of Cardiology, Tokushima Red Cross Hospital
Koichi Kishi
Department of Cardiology, Tokushima Red Cross Hospital
Ryuji Ohtani
Department of Cardiology, Tokushima Red Cross Hospital

Keywords: Delayed neointimal coverage, Drug-eluting stent, Lipid-laden-like neointima, Optical coherence tomography, Very late stent thrombosis

JOURNAL FREE ACCESS

2012 Volume 76 Issue 2 Pages 390-398

DOI https://doi.org/10.1253/circj.CJ-11-0961

View "Advance Publication" version (December 1, 2011).

Details

Abstract

Background: Autopsy findings have suggested delayed arterial healing as a primary cause of very late stent thrombosis (VLST) after drug-eluting stent (DES) implantation. Methods and Results: Optical coherence tomography of DES-treated lesions that developed VLST (n=6) was compared with that of DES-treated lesions that developed late in-stent restenosis (L-ISR: n=32) among patients with recurrent ischemia >1 year after DES implantation (mean, 37±17 months), and with the stented segment without any evidence of VLST or L-ISR (no-event: n=20; mean, 38±19 months). The proportion of uncovered and malapposed struts in each stented segment was evaluated. A total of 961 frames, 9,763 struts were analyzed. The proportion of uncovered struts was higher in the VLST group than in the L-ISR group and the no-event group (29.2±22.8%, 7.9±9.7%, and 7.6±8.0%, respectively; P=0.0002). The proportion of malapposed struts was higher in the VLST group than in the no-event group (7.3±8.7% vs 1.1±2.4%, P=0.01). Two patients in the VLST group had lower rates of uncovered and malapposed struts, but this involved lipid-laden-like neointima with disruptions. Conclusions: Delayed neointimal coverage and incomplete stent apposition were frequently observed in the DES-treated lesions that developed very late thrombosis. Lipid-laden-like neointima with disruption within the DES may be another possible mechanism for very late thrombosis. (Circ J 2012; 76: 390-398)

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