Characteristics of Earlier Versus Delayed Presentation of Very Late Drug-Eluting Stent Thrombosis: An Optical Coherence Tomographic Study
- Authors
- Lee, Seung-Yul; Ahn, Jung-Min; Mintz, Gary S.; Hur, Seung-Ho; Choi, So-Yeon; Kim, Sang-Wook; Cho, Jin Man; Hong, Soon Jun; Kim, Jin Won; Hong, Young Joon; Lee, Sang-Gon; Shin, Dong-Ho; Kim, Jung-Sun; Kim, Byeong-Keuk; Ko, Young-Guk; Choi, Donghoon; Jang, Yangsoo; Park, Seung-Jung; Hong, Myeong-Ki
- Issue Date
- 4월-2017
- Publisher
- WILEY
- Keywords
- coronary artery disease; drug-eluting stent; optical coherence tomography
- Citation
- JOURNAL OF THE AMERICAN HEART ASSOCIATION, v.6, no.4
- Indexed
- SCIE
SCOPUS
- Journal Title
- JOURNAL OF THE AMERICAN HEART ASSOCIATION
- Volume
- 6
- Number
- 4
- URI
- https://scholar.korea.ac.kr/handle/2021.sw.korea/83966
- DOI
- 10.1161/JAHA.116.005386
- ISSN
- 2047-9980
- Abstract
- Background-The pathophysiology underlying very late drug-eluting stent (DES) thrombosis is not sufficiently understood. Using optical coherence tomography, we investigated characteristics of very late stent thrombosis (VLST) according to different onset times. Methods and Results-A total of 98 patients from 10 South Korean hospitals who underwent optical coherence tomography for evaluation of very late DES thrombosis were retrospectively included in analyses. VLST occurred at a median of 55.1 months after DES implantation. All patients were divided into 2 equal groups of earlier versus delayed presentation of VLST, according to median onset time. In total, 27 patients were treated with next-generation DES and 71 with first-generation DES. Based on optical coherence tomography findings at thrombotic sites, main VLST mechanisms were as follows, in descending order: neoatherosclerosis (34.7%), stent malapposition (33.7%), and uncovered struts without stent malapposition or evagination (24.5%). Compared with patients with earlier VLST, patients with delayed VLST had lower frequency of uncovered struts without stent malapposition or evagination (34.7% versus 14.3%, respectively; P=0.019). Conversely, the frequency of neoatherosclerosis was higher in patients with delayed versus earlier VLST (44.9% versus 24.5%, respectively; P=0.034). The frequency of stent malapposition was not different between patients with earlier and delayed VLST (34.7% versus 32.7%, respectively; P=0.831). The frequency of stent malapposition, evagination, and uncovered struts was still half of delayed VLST. Conclusions-The pathological mechanisms of very late DES thrombosis changed over time. Delayed neointimal healing remained a substantial substrate for VLST, even long after DES implantation.
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Collections - Graduate School > Department of Biomedical Sciences > 1. Journal Articles
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