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 |
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| Hlavní autoři: | , , , , , , , , , , , , , , , , , , , |
| Médium: | Journal Article |
| Jazyk: | angličtina |
| Vydáno: |
England
14.04.2016
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| Témata: | |
| ISSN: | 1522-9645, 1522-9645 |
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| Abstract | 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. |
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| AbstractList | 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. 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.AIMSAngiography 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%).METHODS AND RESULTSA 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.CONCLUSIONIn patients with confirmed ST, OCT imaging identified an underlying morphological abnormality in 97% of cases. |
| Author | Teiger, Emmanuel Caussin, Christophe Souteyrand, Geraud Vanzetto, Gerald Trouillet, Charlotte Mangin, Lionel Belle, Loic Mulliez, Aurélien Lhermusier, Thibault Rangé, Gregoire Amabile, Nicolas Dubreuil, Olivier Meneveau, Nicolas Delaunay, Regis Levesque, Sebastien Motreff, Pascal Chabin, Xavier Cayla, Guillaume Barnay, Pierre Rioufol, Gilles |
| Author_xml | – sequence: 1 givenname: Geraud surname: Souteyrand fullname: Souteyrand, Geraud email: gsouteyrand@chu-clermontferrand.fr organization: Cardiology Department, CHU Clermont-Ferrand, Clermont-Ferrand 63000, France Cardio Vascular Interventional Therapy and Imaging (CaVITI), UMR CNRS 6284, Auvergne University, Clermont-Ferrand, France gsouteyrand@chu-clermontferrand.fr – sequence: 2 givenname: Nicolas surname: Amabile fullname: Amabile, Nicolas organization: Cardiology Department, Institut Mutualiste Montsouris, Paris, France – sequence: 3 givenname: Lionel surname: Mangin fullname: Mangin, Lionel organization: Cardiology Department, CH Annecy, Annecy, France – sequence: 4 givenname: Xavier surname: Chabin fullname: Chabin, Xavier organization: Cardiology Department, CHU Clermont-Ferrand, Clermont-Ferrand 63000, France Cardio Vascular Interventional Therapy and Imaging (CaVITI), UMR CNRS 6284, Auvergne University, Clermont-Ferrand, France – sequence: 5 givenname: Nicolas surname: Meneveau fullname: Meneveau, Nicolas organization: Cardiology Department, CHU Besançon, Besançon, France – sequence: 6 givenname: Guillaume surname: Cayla fullname: Cayla, Guillaume organization: Cardiology Department, CHU Nimes, Nimes, France – sequence: 7 givenname: Gerald surname: Vanzetto fullname: Vanzetto, Gerald organization: Cardiology Department, CHU Grenoble, Grenoble, France – sequence: 8 givenname: Pierre surname: Barnay fullname: Barnay, Pierre organization: Cardiology Department, CH Henri Duffaut, Avignon, France – sequence: 9 givenname: Charlotte surname: Trouillet fullname: Trouillet, Charlotte organization: Cardiology Department, CH La Rochelle-Re-Aunis, La Rochelle, France – sequence: 10 givenname: Gilles surname: Rioufol fullname: Rioufol, Gilles organization: Cardiology Department, Hospices Civils de Lyon, Bron, France – sequence: 11 givenname: Gregoire surname: Rangé fullname: Rangé, Gregoire organization: Cardiology Department, CH Chartres, Chartres, France – sequence: 12 givenname: Emmanuel surname: Teiger fullname: Teiger, Emmanuel organization: Cardiology Department, CHU Henri Mondor-Assistance Publique-Hôpitaux de Paris, Creteil, France – sequence: 13 givenname: Regis surname: Delaunay fullname: Delaunay, Regis organization: Cardiology Department, CH St Brieuc, St Brieuc, France – sequence: 14 givenname: Olivier surname: Dubreuil fullname: Dubreuil, Olivier organization: Cardiology Department, St Luc-St Joseph hospital, Lyon, France – sequence: 15 givenname: Thibault surname: Lhermusier fullname: Lhermusier, Thibault organization: Department of Cardiology, CHU Rangueil, Toulouse, France – sequence: 16 givenname: Aurélien surname: Mulliez fullname: Mulliez, Aurélien organization: Bio-Statistics Unit, délégation recherche clinique & innovation, CHU de Clermont-Ferrand, France – sequence: 17 givenname: Sebastien surname: Levesque fullname: Levesque, Sebastien organization: Cardiology Department, CHU Poitiers, Poitiers, France – sequence: 18 givenname: Loic surname: Belle fullname: Belle, Loic organization: Cardiology Department, CH Annecy, Annecy, France – sequence: 19 givenname: Christophe surname: Caussin fullname: Caussin, Christophe organization: Cardiology Department, Institut Mutualiste Montsouris, Paris, France – sequence: 20 givenname: Pascal surname: Motreff fullname: Motreff, Pascal organization: Cardiology Department, CHU Clermont-Ferrand, Clermont-Ferrand 63000, France Cardio Vascular Interventional Therapy and Imaging (CaVITI), UMR CNRS 6284, Auvergne University, Clermont-Ferrand, France |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/26757787$$D View this record in MEDLINE/PubMed |
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| Copyright | Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2016. For permissions please email: journals.permissions@oup.com. |
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| DOI | 10.1093/eurheartj/ehv711 |
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| Issue | 15 |
| Keywords | Stent thrombosis Optical coherence tomography Bare metal stent Drug-eluting stent |
| Language | English |
| License | Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2016. For permissions please email: journals.permissions@oup.com. |
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| References | 27294244 - J Thorac Dis. 2016 Jun;8(6):E460-2 27500366 - J Thorac Dis. 2016 Jul;8(7):1398-405 27747062 - J Thorac Dis. 2016 Sep;8(9):E1057-E1059 26802137 - Eur Heart J. 2016 Apr 14;37(15):1217-9 |
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| Snippet | Angiography has limited value for identifying the causes of stent thrombosis (ST). We studied a large cohort of patients by optical coherence tomography (OCT)... |
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| SubjectTerms | 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 |
| Title | Mechanisms of stent thrombosis analysed by optical coherence tomography: insights from the national PESTO French registry |
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