Comparison of Long‐Term Clinical Outcomes of Lesions Exhibiting Focal and Segmental Peri‐Stent Contrast Staining

Abstract

BackgroundPeri‐stent contrast staining (PSS) after metallic drug‐eluting stent deployment is associated with target lesion revascularization and very late stent thrombosis. However, the type of PSS that influences the clinical outcomes is unknown. Therefore, we aimed to reveal which PSS type was influencing clinical outcomes.Methods and ResultsThis study included 5580 de novo lesions of 4405 patients who were implanted with a first‐ or second‐generation drug‐eluting stent and who were evaluated using follow‐up angiography within 12 months after stent implantation. We compared the clinical outcomes of patients divided into focal PSS and segmental PSS groups for 6 years after stent implantation. Total PSS was observed in 97 lesions (2.2%), of which 42 and 55 lesions were focal and segmental PSS, respectively. Baseline characteristics were similar between groups, except for intraoperative chronic total occlusion (segmental PSS=47.3% versus focal PSS=11.9%, P=0.0001). The incidence of segmental PSS tended to be higher in patients with a first‐generation drug‐eluting stent (83.6% versus 16.4%, P=0.05). The cumulative incidence of stent thrombosis in the 6 years of segmental PSS group was significantly higher than that of the focal PSS group (13.9% versus 0%, P=0.04). The cumulative incidence of overall target lesion revascularization for restenosis, excluding target lesion revascularization procedures for stent thrombosis, was significantly higher in the segmental PSS group (38.0% versus 0%, P=0.01).ConclusionsThe incidence of segmental PSS tended to be higher in patients with a first‐generation drug‐eluting stent and appeared to be significantly associated with target lesion revascularization and stent thrombosis.

Impact of Dual Antiplatelet Therapy Beyond 1 Year on Clinical Outcomes of Patients With Stent Fracture or Peri-Stent Contrast Staining After Sirolimus-Eluting Stent Implantation

“…DES. [19][20][21] We also reported that definite VLST was observed in 1 patient, in which PSS was identified at follow-up CAG and that patient had discontinued all antiplatelet drugs before the onset of VLST. 22 However, we cannot evaluate the efficacy of prolonged DAPT for patients with SF and/ or PSS after everolimus-eluting stents implantation because the rate of VLST was too low.…”

Aneurysmal degeneration of fluoropolymer-coated paclitaxel-eluting stent in the superficial femoral artery: a rising concern

“…In coronary arteries, PSS, that is defined as contrast staining outside the stent contour extending to ≥20% of the stent diameter after drug-eluting stent placement, is rare and has a reported incidence ranging from 1.9% to 2.2% (Imai et al 2011 ; Tokuda et al 2016 ). PSS could be regarded as representing an abnormal response of the vessel wall caused by drug-eluting stent.…”