Post-intervention IVUS is not predictive for very late in-stent thrombosis in drug-eluting stents.

Abstract

OBJECTIVES:

Stent thrombosis is a life-threatening complication associated with sudden death and acute myocardial infarction. Histopathologic studies have linked the occurrence of very late stent thrombosis in drug-eluting stents (DES) with delayed endothealisation and stent malapposition. Our aim was to investigate if late stent malapposition in DES could be predicted by immediate postintervention intra-vascular ultrasonography (IVUS).

METHODS AND RESULTS:

From our MISSION! database of 184 consecutive patients with ST-elevation myocardial infarction (STEMI) who had immediate post-intervention and nine-month follow-up IVUS examinations we prospectively identified three patients with very late (> 365 days) and definite (with angiographic evidence) in-stent thrombosis in DES. Patients had completed the twelve-month clopidogrel-aspirin dual treatment period, two of them were under aspirin therapy while the third patient had aspirin temporarily discontinued before planned surgery. When assessed by serial documentary (immediate post-intervention and nine-month) IVUS, all three patients demonstrated stent malapposition at nine months: in two cases the malapposition was acquired (immediate post-intervention IVUS showed a well apposed stent) and one case presented persistent malapposition (the stent was found malapposed both at immediate post-intervention and nine-month follow-up IVUS).

CONCLUSIONS:

Immediate post-intervention IVUS showing no malapposition does not guarantee an uneventful course after DES implantation.

• Authors: Sandrin C Bergheanu, Bas L Van der Hoeven, Ayman K M Hassan, Jouke Dijkstra, Frits R Rosendaal, Su-San Liem, Martin J Schalij, Johanna G Van der Bom, J Wouter Jukema
• Journal: Acta cardiologica (Acta Cardiol) Vol. 64 Issue 5 Pg. 611-6 (Oct 2009) ISSN: 0001-5385 [Print] England
• PMID: 20058506 (Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)

Topics

• Adult
• Aged, 80 and over
• Angioplasty, Balloon, Coronary (adverse effects)
• Coronary Angiography
• Coronary Thrombosis (diagnostic imaging, etiology)
• Drug-Eluting Stents (adverse effects)
• Electrocardiography
• Female
• Follow-Up Studies
• Humans
• Male
• Middle Aged
• Myocardial Infarction (diagnosis, surgery)
• Predictive Value of Tests
• Prosthesis Failure
• Time Factors
• Ultrasonography, Interventional (methods)