One-year optical coherence tomography findings in patients with late and very-late stent thrombosis treated with intravascular imaging guided percutaneous coronary intervention

Abstract

Patients with late/very-late stent thrombosis (ST) are at high risk of recurrent-ST. The mechanisms of recurrent-ST are largely unknown. The objective is to describe the 1-year optical coherence tomography (OCT) findings of patients suffering from late/very-late ST treated with intravascular imaging guided percutaneous coronary intervention (PCI). All consecutive patients with late/very-late ST undergoing intravascular imaging guided PCI were screened to undergo coronary angiography and OCT examination at 1 year. Patients were classified according to the observation of stent malapposition as most contributing cause of the ST. Thirty-four patients were included. Stent malapposition was observed in 17 (50%) and the remaining 17 cases were classified as: neoatherosclerosis (n = 9), underexpansion (n = 3) and unknown mechanism (n = 5). Patients with malapposition had a remarkable reduction of the malapposition volume (from 6.4 to 1.3 mm; p = 0.02) during the ST procedure, but this was not fully corrected in 13 (76.5%). At 12 months, two patients of the malapposition group presented with uneventful target vessel re-occlusion. Persistent malapposition was observed in nine patients (60.0%). Major coronary evaginations (46.7 vs. 0%; p = 0.001) and uncovered struts (6.3 vs. 1.0%; p < 0.001) were also more frequent in patients with malapposition than without malapposition. None of the patients had thin-cap fibroatheroma neoatherosclerosis. Contributing causes of late/very-late ST are diverse and have different healing patterns at 12 months. Patients with stent malapposition treated with intravascular imaging guided PCI showed poor re-healing; but patients with other causes of the ST showed optimal stent healing as assessed by OCT.

Natriuretic Peptide Clearance Receptor (NPR-C) Pathway as a Novel Therapeutic Target in Obesity-Related Heart Failure With Preserved Ejection Fraction (HFpEF)

“…Maintaining the patency and integrity of the coronary arteries after successful restoration of coronary blood flow is of paramount importance. In patients undergoing PCI, reocclusion of the coronary artery often occurs within 6 months (Khambata et al, 2011;Ñato et al, 2018;Neumann et al, 2019a,b;Sousa-Uva et al, 2019;Modi et al, 2021). For these patients with reocclusion, their CAD is treated with a bare metal stent or drug-eluting stent (DES), which acts as a platform for new tissue growth (Khambata et al, 2011;Sousa-Uva et al, 2019).…”

“…For these patients with reocclusion, their CAD is treated with a bare metal stent or drug-eluting stent (DES), which acts as a platform for new tissue growth (Khambata et al, 2011;Sousa-Uva et al, 2019). Current DESs (which are now the predominant implanted stents) release antiproliferative drugs that inhibit arterial smooth muscle cell proliferation, which is the most predominant cause of restenosis (Khambata et al, 2011;Ñato et al, 2018;Neumann et al, 2019a,b;Sousa-Uva et al, 2019;Modi et al, 2021). However, these agents may also inhibit endothelial cell proliferation (Matter et al, 2006;Khambata et al, 2011;Ñato et al, 2018;Neumann et al, 2019a,b;Sousa-Uva et al, 2019;Modi et al, 2021), which may increase the thrombogenicity of the stent surface.…”

Cardiovascular imaging 2018 in the International Journal of Cardiovascular Imaging

“…The patients were divided at baseline according to the most probable causative factor of ST, such as malapposition (17 patients) or other findings (17 patients) and then re-assed at 1 year follow-up. They found that patients that presented with malapposition are more prone to have a worse healing pattern than those who presented with other causes, thus being at higher risk for recurrent ST [17].…”