Mechanisms of Very Late DES Thrombosis by OCT

Original Title: Mechanisms of Very Late Drug-Eluting Stent Thrombosis Assessed by Optical Coherence Tomography. Reference: Masanori Taniwaki et al. Circulation. 2016 Feb 16;133(7):650-60.

 

The physiopathological mechanisms behind DES thrombosis have not been fully described yet. The potential causes behind this adverse event were assessed using optical computed tomography (OCT).

Between August 2010 and December 2014, 64 patients with instent very late thrombosis were included as part of an international OCT registry.
Very late thrombosis occurred at median 4.7 years after the original procedure (range 3.1 to 7.5 years).

After restoration of flow, OCT pullbacks were performed to analyze 38 first generation DES and 20 new generation DES; a possible cause was observed 98% of times.

The most frequent findings were strut malapposition (34.5%), neo atherosclerosis (27.6%), uncovered struts (12.1%) and stent underexpansion (6.9%).

Uncovered struts and malapposition were more frequent in thrombosed regions vs. non thrombosed.

Maximum stent length with absence or malapposed intimal covering (3.40 mm vs 1.29 mm; p<0.001) was a very strong predictor of thrombosis, but not malapposition distance (distance separating struts from intimal covering).

The combination of malapposition and absence of covering was consistent in both DES generations.

Conclusion
The most frequent causes of very late thrombosis were malapposition, neoatherosclerosis, uncovered struts and underexpansion, across first and new generation DES.

The maximal length of malapposed or uncovered struts showed the highest correlation with very late thrombosis.

More articles by this author

ACC 2025 | FAME 3: FFR Guided PCI vs CABG 5 Year Outcomes.

Earlier studies comparing percutaneous coronary intervention (PCI) vs coronary artery bypass graft (CABG) have shown fewer events at long term for the surgical strategy.  However,...

CRABBIS Trial: Comparison of Different Provisional Stenting Sequences

Provisional stenting (PS) is the gold standard for percutaneous coronary intervention (PCI) in most patients with coronary bifurcation lesions (CBL). Moreover, recent studies such...

Andromeda Trial: Meta-Analysis of Drug Coated Balloon vs. DES in Small Vessel DeNovo Lesions

The use of coronary stents vs plain old balloon angioplasty (POBA), has allowed to reduce recoil and limiting flow dissection which were major limitation...

QFR vs. FFR: Is Coronary Revascularization Deferral Safe? Results from a FAVOR III Sub-Analysis

In cases of intermediate coronary lesions, functional assessment is recommended to aid the decision-making process regarding revascularization. There are several tools currently used to...

LEAVE A REPLY

Please enter your comment!
Please enter your name here

Related Articles

SOLACI Sessionsspot_img

Recent Articles

ACC 2025 | FAME 3: FFR Guided PCI vs CABG 5 Year Outcomes.

Earlier studies comparing percutaneous coronary intervention (PCI) vs coronary artery bypass graft (CABG) have shown fewer events at long term for the surgical strategy.  However,...

ACC 2025 | API-CAT: Reduced vs. Full Dose Extended Anticoagulation in Patients with Cancer Related VTE

The risk of cancer related recurrent venous thromboembolism (VTE) will drop over time, while bleeding risk will persist. At present, it is recommended we...

STRIDE: Semaglutide in Patients with Peripheral Arterial Disease and Type II Diabetes

Peripheral arterial disease (PAD) is a severe complication in patients with type II diabetes, primarily affecting peripheral vessels, especially below-the-knee (BTK) arteries. This condition...