Mechanisms of stent thrombosis analysed by optical coherence tomography: insights from the national PESTO French registry

Angiography has limited value for identifying the causes of stent thrombosis (ST). We studied a large cohort of patients by optical coherence tomography (OCT) to explore ST characteristics and mechanisms. A prospective multicentre registry was screened for patients with confirmed ST. Optical coheren...

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Vydáno v:	European heart journal Ročník 37; číslo 15; s. 1208
Hlavní autoři:	Souteyrand, Geraud, Amabile, Nicolas, Mangin, Lionel, Chabin, Xavier, Meneveau, Nicolas, Cayla, Guillaume, Vanzetto, Gerald, Barnay, Pierre, Trouillet, Charlotte, Rioufol, Gilles, Rangé, Gregoire, Teiger, Emmanuel, Delaunay, Regis, Dubreuil, Olivier, Lhermusier, Thibault, Mulliez, Aurélien, Levesque, Sebastien, Belle, Loic, Caussin, Christophe, Motreff, Pascal
Médium:	Journal Article
Jazyk:	angličtina
Vydáno:	England 14.04.2016
Témata:	Acute Coronary Syndrome - therapy Aged Anticoagulants - therapeutic use Coronary Thrombosis - diagnostic imaging Coronary Thrombosis - etiology Drug-Eluting Stents Female Graft Occlusion, Vascular - diagnostic imaging Graft Occlusion, Vascular - etiology Humans Male Middle Aged Percutaneous Coronary Intervention Platelet Aggregation Inhibitors - therapeutic use Postoperative Complications - diagnostic imaging Prospective Studies Prosthesis Failure Registries Tomography, Optical Coherence - methods Stent thrombosis Optical coherence tomography Bare metal stent Drug-eluting stent
ISSN:	1522-9645, 1522-9645
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Shrnutí:	Angiography has limited value for identifying the causes of stent thrombosis (ST). We studied a large cohort of patients by optical coherence tomography (OCT) to explore ST characteristics and mechanisms. A prospective multicentre registry was screened for patients with confirmed ST. Optical coherence tomography was performed after initial intervention to the culprit lesion (in 69% of cases in a deferred procedure). Stent thrombosis was classified as acute (AST), sub-acute (SAST), late (LST), and very late (VLST). Optical coherence tomography records were analysed in a central core lab. The analysis included 120 subjects aged 61.7 [51.4-70.7]; 89% male. Very late ST was the clinical presentation in 75%, LST in 6%, SAST in 15%, and AST in 4% of patients. Bare metal stents (BMS) were used in 39%, drug-eluting stents (DES) in 59% and bioresorbable vascular scaffolds in 2% of the cases. Optical coherence tomography identified an underlying morphological abnormality in 97% of cases, including struts malapposition (34%), neoatherosclerotic lesions (22%), major stent underexpansion (11%), coronary evagination (8%), isolated uncovered struts (8%), edge-related disease progression (8%), and neointimal hyperplasia (4%). Ruptured neoatherosclerotic lesions were more frequent with BMS than with DES (36 vs. 14%, P = 0.005), whereas coronary evaginations were more frequent with DES than with BMS (12 vs. 2%, P = 0.04). LST + VLST were mainly related to malapposition (31%) and neoatherosclerosis (28%), while prominent mechanisms for AST + SAST were malapposition (48%) and underexpansion (26%). In patients with confirmed ST, OCT imaging identified an underlying morphological abnormality in 97% of cases.
Bibliografie:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 ObjectType-Undefined-3
ISSN:	1522-9645 1522-9645
DOI:	10.1093/eurheartj/ehv711