Identification of Intrastent Pathology Associated With Late Stent Thrombosis Using Optical Coherence Tomography.

Abstract

OBJECTIVE:

To better characterize intrastent pathology using optical coherence tomography (OCT) in patients presenting with late and very late stent thrombosis (LST/VLST).

BACKGROUND:

The contribution of specific intrastent pathologies to the development of LST/VLST is not well understood.

METHODS:

In this single-center, retrospective, observational study of 796 consecutive patients treated for ST-segment elevation myocardial infarction (STEMI) with primary PCI we identified 57 patients (7.2%) in whom STEMI resulted from LST/VLST. Of the patients with LST/VLST, 21 patients (37%) had OCT performed at the discretion of the operator during PCI for LST/VLST. Independent reviewers performed qualitative offline analysis of OCT images to determine the cause of stent thrombosis defined as the specific intrastent pathology associated with thrombus deposition.

RESULTS:

The principal intrastent pathology causing LST/VLST was determined to be stent malapposition in 11 patients (55%), of which 5 (25% of all LST/VLST patents) had findings suggestive of positive vessel remodeling. Neoatherosclerosis was determined to be the cause of LST/VLST in 7 patients (35%). LST/VLST resulted from uncovered stent struts in 2 patients (10%). Among all LST/VLST patients, in-hospital mortality (12.3%) and post-hospital target vessel failure (TVF) or cardiac death (21.7%, median follow-up 1.6 years) remained high. There was a trend towards decreased TVF or cardiac death (7.7% vs. 27.3% P = 0.24) in patients who underwent OCT-guided therapy.

CONCLUSIONS:

LST/VLST remains a significant cause of STEMI and is associated with considerable morbidity and mortality. OCT use at the time of PCI consistently identifies significant intrastent pathology with potentially meaningful clinical impact.

• Authors: Christopher R Jones, Sameer J Khandhar, Mohun Ramratnam, Suresh R Mulukutla, Oscar C Marroquin, Andrew D Althouse, Anjali Rao, Koji Kato, Ik-Kyung Jang, Catalin Toma
• Journal: Journal of interventional cardiology (J Interv Cardiol) Vol. 28 Issue 5 Pg. 439-48 (Oct 2015) ISSN: 1540-8183 [Electronic] United States
• PMID: 26381509 (Publication Type: Journal Article, Observational Study, Research Support, Non-U.S. Gov't)
• Copyright: © 2015, Wiley Periodicals, Inc.

Topics

• Aged
• Coronary Restenosis (diagnosis, etiology, mortality)
• Drug-Eluting Stents (adverse effects)
• Female
• Follow-Up Studies
• Humans
• Male
• Middle Aged
• Myocardial Infarction (diagnosis, therapy)
• Percutaneous Coronary Intervention (adverse effects, instrumentation, methods)
• Reproducibility of Results
• Retreatment (methods, statistics & numerical data)
• Retrospective Studies
• Survival Analysis
• Thrombosis (diagnosis, etiology)
• Time Factors
• Tomography, Optical Coherence (methods)
• United States (epidemiology)