Document Detail


Intravascular ultrasound findings in patients with very late stent thrombosis after either drug-eluting or bare-metal stent implantation.
MedLine Citation:
PMID:  20430265     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: This study compared intravascular ultrasound (IVUS) findings at drug-eluting stent (DES) and bare-metal stent (BMS) sites in patients with very late stent thrombosis (VLST). BACKGROUND: VLST is being increasingly identified since the introduction of DES. VLST can also develop after BMS placement, but the underlying mechanisms remain unknown. METHODS: A total of 30 consecutive VLST patients with acute myocardial infarction (DES, n = 23; BMS, n = 7) were enrolled. Patients underwent IVUS examination before coronary angioplasty. RESULTS: The baseline characteristics were similar for the 2 groups, with the exception of reference vessel size, lesion length, stent length, minimal lumen diameter, and diameter stenosis after the procedure. Overall, VLST occurred at a mean 50.8 +/- 36.2 months after the index procedure, and occurred earlier after DES than BMS (33.2 +/- 12.5 months vs. 108.4 +/- 26.5 months, p < 0.001). IVUS variables were generally similar for the 2 groups. However, plaque burden at the distal reference segment, stent, and neointimal area of the in-stent segment were smaller in the DES group. Stent malapposition was observed in 73.9% of DES patients, but in no BMS patients (p = 0.001). Disease progression with neointimal rupture within the stent was observed in 10 DES patients (43.5%) and 7 BMS patients (100%; p = 0.010). CONCLUSIONS: Stent malapposition was unique to DES-related VLST, whereas disease progression with neointimal rupture was more common in BMS patients. These findings suggest that different biological mechanisms underlie VLST development depending upon the stent type.
Authors:
Cheol Whan Lee; Su-Jin Kang; Duk-Woo Park; Seung-Hwan Lee; Young-Hak Kim; Jae-Joong Kim; Seong-Wook Park; Gary S Mintz; Seung-Jung Park
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  55     ISSN:  1558-3597     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2010 May 
Date Detail:
Created Date:  2010-04-30     Completed Date:  2010-05-13     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1936-42     Citation Subset:  AIM; IM    
Copyright Information:
Copyright 2010 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Affiliation:
Department of Medicine, Asan Medical Center, University of Ulsan, Seoul, Korea.
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MeSH Terms
Descriptor/Qualifier:
Adult
Angioplasty, Transluminal, Percutaneous Coronary / adverse effects
Coronary Thrombosis / radiography,  ultrasonography*
Disease Progression
Drug-Eluting Stents / adverse effects*
Female
Humans
Male
Middle Aged
Myocardial Infarction / therapy*,  ultrasonography
Prosthesis Failure
Stents / adverse effects*
Time Factors
Ultrasonography, Interventional
Comments/Corrections
Comment In:
J Am Coll Cardiol. 2010 May 4;55(18):1943-4   [PMID:  20430266 ]

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