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Mechanisms of Very Late Stent Thrombosis in Japanese Patients as Assessed by Optical Coherence Tomography.
- Source :
-
The Canadian journal of cardiology [Can J Cardiol] 2024 Apr; Vol. 40 (4), pp. 696-704. Date of Electronic Publication: 2023 Dec 02. - Publication Year :
- 2024
-
Abstract
- Background: Although very late stent thrombosis (VLST) remains an important concern, the underlying etiology and clinical characteristics are not fully elucidated in Japanese patients who undergo intravascular imaging-guided percutaneous coronary intervention (PCI) regularly.<br />Methods: We identified 50 VLST lesions (bare-metal stent [BMS] [n = 16], first-generation drug-eluting stent [DES] [n = 14] and newer-generation DES [n = 20]) in patients managed in our institutes. The underlying mechanism of VLST was assessed by optical coherence tomography (OCT), and the major etiology of each lesion was determined. The aim of this study was to explore the mechanisms of VLST of BMSs and DESs in Japanese patients.<br />Results: The median duration since stent implantation was 10 years (range: 1-20). The most frequent etiology of VLST was neoatherosclerotic rupture (44%), followed by neointimal erosion (24%). Edge disease (10%) and evagination (10%) were similarly observed. Malapposition (8%) was deemed to be acquired late by looking at intravascular imaging from the index procedure. Uncovered struts (2%) and in-stent calcified nodule (2%) were the least frequent etiologies. Regardless of etiology, signs of neoatherosclerosis were present in most lesions (82%). Most patients received single (68%) or dual (8%) antiplatelet therapy or oral anticoagulation alone (4%), whereas a considerable proportion of patients discontinued medication (20%). Regarding the treatment strategy, drug-coated balloon was the most frequent strategy (56%), followed by implantation of newer DESs (34%).<br />Conclusions: Various mechanisms have been identified in Japanese patients with VLST. In these patients, biological responses seemed to be more relevant than the index procedure-related factors.<br /> (Copyright © 2023 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Humans
Tomography, Optical Coherence methods
Japan epidemiology
Stents adverse effects
Treatment Outcome
Coronary Vessels diagnostic imaging
Coronary Vessels pathology
Drug-Eluting Stents adverse effects
Coronary Thrombosis etiology
Percutaneous Coronary Intervention adverse effects
Coronary Artery Disease diagnosis
Coronary Artery Disease surgery
Coronary Artery Disease complications
Subjects
Details
- Language :
- English
- ISSN :
- 1916-7075
- Volume :
- 40
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- The Canadian journal of cardiology
- Publication Type :
- Academic Journal
- Accession number :
- 38043704
- Full Text :
- https://doi.org/10.1016/j.cjca.2023.11.034