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One-year optical coherence tomography findings in patients with late and very-late stent thrombosis treated with intravascular imaging guided percutaneous coronary intervention

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Abstract

Patients with late/very-late stent thrombosis (ST) are at high risk of recurrent-ST. The mechanisms of recurrent-ST are largely unknown. The objective is to describe the 1-year optical coherence tomography (OCT) findings of patients suffering from late/very-late ST treated with intravascular imaging guided percutaneous coronary intervention (PCI). All consecutive patients with late/very-late ST undergoing intravascular imaging guided PCI were screened to undergo coronary angiography and OCT examination at 1 year. Patients were classified according to the observation of stent malapposition as most contributing cause of the ST. Thirty-four patients were included. Stent malapposition was observed in 17 (50%) and the remaining 17 cases were classified as: neoatherosclerosis (n = 9), underexpansion (n = 3) and unknown mechanism (n = 5). Patients with malapposition had a remarkable reduction of the malapposition volume (from 6.4 to 1.3 mm3; p = 0.02) during the ST procedure, but this was not fully corrected in 13 (76.5%). At 12 months, two patients of the malapposition group presented with uneventful target vessel re-occlusion. Persistent malapposition was observed in nine patients (60.0%). Major coronary evaginations (46.7 vs. 0%; p = 0.001) and uncovered struts (6.3 vs. 1.0%; p < 0.001) were also more frequent in patients with malapposition than without malapposition. None of the patients had thin-cap fibroatheroma neoatherosclerosis. Contributing causes of late/very-late ST are diverse and have different healing patterns at 12 months. Patients with stent malapposition treated with intravascular imaging guided PCI showed poor re-healing; but patients with other causes of the ST showed optimal stent healing as assessed by OCT.

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Funding

This study was funded by Abbott Vascular Spain.

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Author notes

  1. Marcos Ñato and Josep Gomez-Lara contributed equally to this work.

Authors and Affiliations

  1. Interventional Cardiology Department, Hospital Universitari de Bellvitge, c/ Feixa Llarga sn, L’Hospitalet de Llobregat, Spain

    Marcos Ñato, Josep Gomez-Lara, Rafael Romaguera, Gerard Roura, José Luis Ferreiro, Luis Teruel, Montserrat Gracida, Lara Fuentes, Bert Vandeloo, Joan-Antoni Gomez-Hospital & Angel Cequier

  2. Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), L’Hospitalet de Llobregat, Spain

    Marcos Ñato, Josep Gomez-Lara, Rafael Romaguera, Gerard Roura, José Luis Ferreiro, Luis Teruel, Montserrat Gracida, Lara Fuentes, Bert Vandeloo, Joan-Antoni Gomez-Hospital & Angel Cequier

  3. Universitat de Barcelona, L’Hospitalet de Llobregat, Spain

    Marcos Ñato, Josep Gomez-Lara, Rafael Romaguera, Gerard Roura, José Luis Ferreiro, Luis Teruel, Montserrat Gracida, Lara Fuentes, Bert Vandeloo, Joan-Antoni Gomez-Hospital & Angel Cequier

Authors
  1. Marcos Ñato
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  2. Josep Gomez-Lara
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  3. Rafael Romaguera
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  4. Gerard Roura
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  5. José Luis Ferreiro
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  6. Luis Teruel
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  7. Montserrat Gracida
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  8. Lara Fuentes
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  9. Bert Vandeloo
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  10. Joan-Antoni Gomez-Hospital
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  11. Angel Cequier
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Corresponding author

Correspondence to Josep Gomez-Lara.

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None of the authors declare conflict of interest with the present study.

Ethical approval

All procedures were in accordance with the ethical standards of the local ethic´s committee and with the 1964 declaration of Helsinki and its later amendments.

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Ñato, M., Gomez-Lara, J., Romaguera, R. et al. One-year optical coherence tomography findings in patients with late and very-late stent thrombosis treated with intravascular imaging guided percutaneous coronary intervention. Int J Cardiovasc Imaging 34, 1511–1520 (2018). https://doi.org/10.1007/s10554-018-1372-7

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  • DOI: https://doi.org/10.1007/s10554-018-1372-7

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