Stent Fracture and Peri-Stent Contrast Staining After Everolimus-Eluting Stent Implantation　― 5-Year Outcomes ―

Abstract

tion. Although PSS occurs at a low frequency, it has been reported as a risk factor for ST and TLR after first-generation DES implantation and a potential risk factor of adverse events after second-generation DES implantation. 15-17 We aimed to investigate the effect of SF and PSS on 5-year clinical outcomes after EES implantation. Methods Patient PopulationThis study was a retrospective single-center study. A total of 1,013 consecutive patients (1,716 lesions) undergoing EES (Xience V, Abbott Vascular, Santa Clara, CA, USA) implantation between January and December 2010 were enrolled. The exclusion criteria were repeat EES implantation and the combined use of EES and other types of stent. Finally, we analyzed 636 patients (1,081 lesions) exclusively treated using EES and undergoing follow-up angiography within 1 year (Figure 1). Clinical outcomes were compared between the groups of lesions with and without F irst-generation drug-eluting stents (DES) have resulted in a substantial reduction in in-stent restenosis and the need for subsequent target lesion revascularization (TLR) compared with bare-metal stents. 1,2 Everolimus-eluting stents (EES) are a second-generation DES, designed to improve safety, efficacy, and device performance with a newer antiproliferative drug, a durable polymer, improved stent design, and thinner struts. Compared with bare-metal stents and first-generation DES, EES have reduced adverse events as reported in randomized control trials and meta-analyses. 3-7 Recently, stent fracture (SF) after DES implantation has become a concern because of its association with adverse events such as in-stent restenosis (ISR), stent thrombosis (ST), and subsequent TLR. 8-10 Previous studies have reported that SF after sirolimus-eluting stent (SES) implantation is associated with ISR and higher cardiac event rates. 11-13 This association is reported even in patients treated with second-generation DES. 14 Peri-stent contrast staining (PSS) is contrast staining outside stent struts after stent implanta- Background: Stent fracture (SF) and peri-stent contrast staining (PSS) after sirolimus-eluting stent implantation are reported to be risk factors of adverse events. However, the effect of these after everolimus-eluting stent (EES) implantation on long-term outcomes remains unclear.

Very Late Stent Thrombosis after Discontinuation of Antiplatelet Agents during Anticoagulation Therapy in a Patient with Peri-stent Contrast Staining after Implantation of a Second-generation Drug-eluting Stent

“…A previous study reported that the incidence of definite stent thrombosis was 8.2% at 3 years in patients with PSS after firstgeneration DES implantation, and a representative case of VLST, when all antiplatelet drugs were discontinued at the time of non-cardiac surgery, was described (8). In another study, antiplatelet drugs were discontinued in all patients who developed VLST, despite PSS being observed after EES implantation (13).…”

Incidence of coronary drug-eluting stent fracture: A systematic review and meta-analysis

“…On the one hand, the closed-cell design and stainless steel stent struts of first-generation DESs resulted in poor flexibility and conformability. However, second-generation stents, characterized by thinner struts, an open-cell design and increased radial strength, tolerated fatigue and reduced the incidence of CSF, as clinical studies have identified ( 6 , 7 , 52 , 53 ). On the other hand, some new-generation DESs, such as Promus Element, had a significantly higher risk of longitudinal compression, especially when employed for ostial lesions ( 47 ).…”

“…Especially in recent years, the thinner steel beam thickness in the new generation of alloy stents and the wide use of intraluminal imaging technology have led to a significant increase in the incidence of CSF in clinical practice ( 3 – 5 ). In addition, serious clinical cardiovascular events such as in-stent restenosis (ISR), stent thrombus (ST), coronary artery aneurysm and coronary perforation induced by CSF have threatened patients’ health ( 6 – 8 ). In addition, trials assessing the incidence of CSF and related risk factors for CSF have recently been published and added to the evidence base.…”

Coronary Stent Fracture Causing Myocardial Infarction: Case Report and Review of Literature

“…In a recent individual patient pooled study analysis, Madhavan et al [60] showed an incidence of very late stent-related events of 2% per year with all stent types, without an evident plateau over time. SF is one proposed mechanism of stent failure and is known as a major risk factor for ISR, stent thrombosis, TLR and MACE [11,13,15,40,42,[81][82][83]. From their meta-analysis, Chakravarty et al [13] report a significantly higher risk for ISR (38% vs. 8.2%, p < 0.001) and TLR (17% vs. 5.6%, p < 0.001) in lesions with fractured stents.…”

“…[ 60 ] showed an incidence of very late stent-related events of 2% per year with all stent types, without an evident plateau over time. SF is one proposed mechanism of stent failure and is known as a major risk factor for ISR, stent thrombosis, TLR and MACE [ 11 , 13 , 15 , 40 , 42 , 81 , 82 , 83 ]. From their meta-analysis, Chakravarty et al .…”