Document Detail

A volumetric intravascular ultrasound comparison of early drug-eluting stent thrombosis versus restenosis.
MedLine Citation:
PMID:  19463466     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: We compared intravascular ultrasound findings of drug-eluting stent (DES)-treated lesions that developed thrombosis versus in-stent restenosis (ISR).
BACKGROUND: Stent underexpansion is a predictor of both DES thrombosis and ISR. However, all underexpanded DES may not be equal.
METHODS: Intravascular ultrasound findings from 20 definite DES thrombosis patients (representing all definite thromboses from 1,407 consecutive DES patients undergoing intravascular ultrasound imaging) were compared with 50 risk-factor-balanced ISR patients with no evidence of stent thrombosis and 50 risk-factor-balanced "no-event" patients with neither thrombosis nor ISR.
RESULTS: Minimum stent area (3.9 +/- 1.0 mm(2) vs. 5.0 +/- 1.7 mm(2), p = 0.008), mean stent area (5.3 +/- 1.0 mm(2) vs. 7.2 +/- 2.0 mm(2), p = 0.001), and both focal (55.4 +/- 13.2% vs. 74.9 +/- 19.9%, p < 0.001) and diffuse stent expansion (77.4 +/- 19.3% vs. 109.5 +/- 23.1%, p < 0.001) were significantly smaller in the stent thrombosis group versus ISR and in both groups versus the "no-event" group. Minimum stent area <4.0 mm(2) (65% vs. 32%, p = 0.01) or <5.0 mm(2) (85% vs. 52%, p = 0.01) was more common in the stent thrombosis versus the ISR group and in both groups vs. "no-event" patients; and the relative length of the stent area <5 mm(2) was greatest in the stent thrombosis group (36.6 +/- 37.7%), intermediate in the ISR group (22.8 +/- 35.6%), and least in the "no-event" group (10.9 +/- 26.4%), p = 0.04. In the stent thrombosis group, the minimum stent area site occurred in the proximal stent segment in 50% versus 24% in the ISR group (p = 0.03). There were no differences in edge dissection, stent fracture, or stent-vessel-wall malapposition among the groups.
CONCLUSIONS: The DES-treated lesions that develop thrombosis or restenosis are often underexpanded, but underexpansion associated with thrombosis is more severe, diffuse, and proximal in location.
Xuebo Liu; Hiroshi Doi; Akiko Maehara; Gary S Mintz; Jose de Ribamar Costa; Koichi Sano; Giora Weisz; George D Dangas; Alexandra J Lansky; Edward M Kreps; Michael Collins; Martin Fahy; Gregg W Stone; Jeffrey W Moses; Martin B Leon; Roxana Mehran
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  JACC. Cardiovascular interventions     Volume:  2     ISSN:  1876-7605     ISO Abbreviation:  JACC Cardiovasc Interv     Publication Date:  2009 May 
Date Detail:
Created Date:  2009-05-25     Completed Date:  2010-09-29     Revised Date:  2014-09-05    
Medline Journal Info:
Nlm Unique ID:  101467004     Medline TA:  JACC Cardiovasc Interv     Country:  United States    
Other Details:
Languages:  eng     Pagination:  428-34     Citation Subset:  IM    
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MeSH Terms
Analysis of Variance
Aspirin / therapeutic use
Coronary Restenosis / drug therapy,  prevention & control*,  ultrasonography
Coronary Thrombosis / drug therapy,  physiopathology,  therapy*,  ultrasonography
Drug-Eluting Stents*
Middle Aged
Retrospective Studies
Risk Factors
Ticlopidine / analogs & derivatives,  therapeutic use
Time Factors
Ultrasonography, Interventional*
Reg. No./Substance:
A74586SNO7/clopidogrel; OM90ZUW7M1/Ticlopidine; R16CO5Y76E/Aspirin
Comment In:
JACC Cardiovasc Interv. 2009 May;2(5):435-6   [PMID:  19463467 ]
JACC Cardiovasc Interv. 2009 Aug;2(8):807   [PMID:  19695553 ]

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