Delayed neointimal coverage on incompletely apposed and side branch struts noted by coherence tomography
Delayed neointimal coverage on incompletely apposed stent struts: Delayed stent thrombosis is a nightmare of interventional cardiologists in the era of drug eluting stents. It can occur even long years after stent implantation, especially during withdrawal of anti platelet agent for a needed surgical procedure. Pathological studies have shown that incomplete neointimal coverage as a substrate for very late stent thrombosis. Intravascular ultrasound studies have shown the link between incomplete stent apposition and stent thrombosis. Juan Luis Gutiérrez-Chico 1, Evelyn Regar, Eveline Nüesch, Takayuki Okamura, Joanna Wykrzykowska, Carlo di Mario, Stephan Windecker, Gerrit-Anne van Es, Pierre Gobbens, Peter Jüni and Patrick W Serruys [1] have tried to find out the link between delayed stent thrombosis and incomplete stent thrombosis by in vivo optical coherence tomographic studies. Their study sample included 38 sirolimus-eluting, 33 biolimus-eluting, 57 everolimus-eluting, and 50 zotarolimus-eluting stents in ninety nine patients, with a total of over thirty four thousand stent struts. The risk ratio of delayed neointimal coverage was found to be 9 for nonapposed side branch struts and 9.1 for incomplete stent apposition, compared with well apposed stent struts.
Reference
- Juan Luis Gutiérrez-Chico, Evelyn Regar, Eveline Nüesch, Takayuki Okamura, Joanna Wykrzykowska, Carlo di Mario, Stephan Windecker, Gerrit-Anne van Es, Pierre Gobbens, Peter Jüni, Patrick W Serruys. Delayed Coverage in Malapposed and Side-Branch Struts With Respect to Well-Apposed Struts in Drug-Eluting Stents: In Vivo Assessment With Optical Coherence Tomography. Circulation. 2011 Aug 2;124(5):612-23.