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Revista Española de Cardiología (English Edition) Revista Española de Cardiología (English Edition)
Rev Esp Cardiol. 2018;71:335-43 - Vol. 71 Num.05 DOI: 10.1016/j.rec.2017.08.001

IVUS Findings in Late and Very Late Stent Thrombosis. A Comparison Between Bare-metal and Drug-eluting Stents

Lara Fuentes a,, Josep Gómez-Lara a, Neus Salvatella b, Nieves Gonzalo c, Felipe Hernández-Hernández d, Eduard Fernández-Nofrerias e, Ángel Sánchez-Recalde f, Fernando Alfonso g, Rafael Romaguera a, José Luis Ferreiro a, Gerard Roura a, Luis Teruel a, Montserrat Gracida a, Ana Lucrecia Marcano a, Joan-Antoni Gómez-Hospital a, Ángel Cequier a

a Departamento de Cardiología Intervencionista, Hospital Universitari de Bellvitge, Institut d’ Investigació Biomèdica de Bellvitge (IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain
b Departamento de Cardiología Intervencionista, Hospital del Mar, Barcelona, Spain
c Departamento de Cardiología Intervencionista, Hospital Clínico San Carlos, Madrid, Spain
d Departamento de Cardiología Intervencionista, Hospital 12 de Octubre, Madrid, Spain
e Departamento de Cardiología Intervencionista, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain
f Departamento de Cardiología Intervencionista, Hospital La Paz, Madrid, Spain
g Departamento de Cardiología Intervencionista, Hospital de La Princesa, Madrid, Spain

Keywords

Bare-metal stents. Drug-eluting stents. Intravascular ultrasound. Percutaneous coronary intervention. Stent thrombosis.

Abstract

Introduction and objectives

Stent thrombosis (ST) is a life-threatening complication after stent implantation. Intravascular ultrasound is able to discern most causes of ST. The aim of this study was to compare intravascular ultrasound findings between bare-metal stents (BMS) and drug-eluting stents (DES) in patients with late (31 days to 1 year) or very late ST (> 1 year).

Methods

Of 250 consecutive patients with late or very late ST in 7 Spanish institutions, 114 patients (45.5% BMS and 54.5% DES) were imaged with intravascular ultrasound. Off-line intravascular ultrasound analysis was performed to assess malapposition, underexpansion, and neoatherosclerosis.

Results

The median time from stent implantation to ST was 4.0 years with BMS and 3.4 years with DES (P = .04). Isolated malapposition was similarly observed in both groups (36.5% vs 46.8%; P = .18) but was numerically lower with BMS (26.6% vs 48.0%; P = .07) in patients with very late ST. Isolated underexpansion was similarly observed in both groups (13.5% vs 11.3%; P = .47). Isolated neoatherosclerosis occurred only in patients with very late ST and was more prevalent with BMS (22.9%) than with DES (6.0%); P = .02. At 2.9 years’ follow-up, there were 0% and 6.9% cardiac deaths, respectively (P = .06) and recurrent ST occurred in 4.0% and 5.2% of patients, respectively (P = .60).

Conclusions

Malapposition was the most common finding in patients with late and very late ST and is more prevalent with DES in very late ST. In contrast, neoatherosclerosis was exclusively observed in patients with very late ST and mainly with BMS.

1885-5857/© 2018 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved