Optical Coherence Tomography Findings in Patients With Coronary Stent Thrombosis A Report of the PRESTIGE Consortium (Prevention of Late Stent Thrombosis by an Interdisciplinary Global European Effort)
| Autor: | Laurent J. Feldman, Thea C. Godschalk, Adnan Kastrati, Robert A. Byrne, Fernando Alfonso, Jurriën M. ten Berg, Ton Heestermans, Dries De Cock, Vasile Sirbu, Nikesh Malik, J Cuesta, Franz-Josef Neumann, Michael Joner, Tomohisa Tada, Alison H. Goodall, Ota Hlinomaz, Tom Adriaenssens, Anthony H. Gershlick, Ann Belmans, Steffen Massberg, Giulio Guagliumi, Ian Buysschaert, Walter Desmet, Kenichi Komukai, Erion Xhepa |
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| Přispěvatelé: | UAM. Departamento de Medicina, Instituto de Investigación del Hospital de La Princesa (IP) |
| Jazyk: | angličtina |
| Rok vydání: | 2017 |
| Předmět: |
Male
Research Report genetic structures medicine.medical_treatment Tomography optical coherence 030204 cardiovascular system & hematology 0302 clinical medicine Coronary thrombosis 030212 general & internal medicine Stent thrombosis Prospective Studies Registries medicine.diagnostic_test Drug-Eluting Stents Thrombosis malapposition Malapposition Europe stents atherosclerosis thrombosis tomography optical coherence uncovered struts Stents Female Radiology Cardiology and Cardiovascular Medicine medicine.medical_specialty Medicina 03 medical and health sciences Percutaneous Coronary Intervention Optical coherence tomography Physiology (medical) Coronary stent medicine Humans tomography optical coherence In patient Aged business.industry Coronary Thrombosis Percutaneous coronary intervention Uncovered struts medicine.disease Atherosclerosis equipment and supplies eye diseases sense organs Complication business |
| Zdroj: | Biblos-e Archivo: Repositorio Institucional de la UAM Universidad Autónoma de Madrid Repositorio Institucional de la Consejería de Sanidad de la Comunidad de Madrid Consejería de Sanidad de la Comunidad de Madrid Biblos-e Archivo. Repositorio Institucional de la UAM instname |
| Popis: | Background: Stent thrombosis (ST) is a serious complication following coronary stenting. Intravascular optical coherence tomography (OCT) may provide insights into mechanistic processes leading to ST. We performed a prospective, multicenter study to evaluate OCT findings in patients with ST. Methods: Consecutive patients presenting with ST were prospectively enrolled in a registry by using a centralized telephone registration system. After angiographic confirmation of ST, OCT imaging of the culprit vessel was performed with frequency domain OCT. Clinical data were collected according to a standardized protocol. OCT acquisitions were analyzed at a core laboratory. Dominant and contributing findings were adjudicated by an imaging adjudication committee. Results: Two hundred thirty-one patients presenting with ST underwent OCT imaging; 14 (6.1%) had image quality precluding further analysis. Of the remaining patients, 62 (28.6%) and 155 (71.4%) presented with early and late/very late ST, respectively. The underlying stent type was a newgeneration drug-eluting stent in 50.3%. Mean reference vessel diameter was 2.9±0.6 mm and mean reference vessel area was 6.8±2.6 mm 2 . Stent underexpansion (stent expansion index < 0.8) was observed in 44.4% of patients. The predicted average probability (95% confidence interval) that any frame had uncovered (or thrombus-covered) struts was 99.3% (96.1-99.9), 96.6% (92.4-98.5), 34.3% (15.0-60.7), and 9.6% (6.2-14.5) and malapposed struts was 21.8% (8.4-45.6), 8.5% (4.6-15.3), 6.7% (2.5-16.3), and 2.0% (1.2-3.3) for acute, subacute, late, and very late ST, respectively. The most common dominant finding adjudicated for acute ST was uncovered struts (66.7% of cases); for subacute ST, the most common dominant finding was uncovered struts (61.7%) and underexpansion (25.5%); for late ST, the most common dominant finding was uncovered struts (33.3%) and severe restenosis (19.1%); and for very late ST, the most common dominant finding was neoatherosclerosis (31.3%) and uncovered struts (20.2%). In patients presenting very late ST, uncovered stent struts were a common dominant finding in drug-eluting stents, and neoatherosclerosis was a common dominant finding in bare metal stents. Conclusions: In patients with ST, uncovered and malapposed struts were frequently observed with the incidence of both decreasing with longer time intervals between stent implantation and presentation. The most frequent dominant observation varied according to time intervals from index stenting: uncovered struts and underexpansion in acute/subacute ST and neoatherosclerosis and uncovered struts in late/very late ST Funding: The research leading to these results has received funding from the European Union Seventh Framework Programme FP7/2007-2013 under grant agreement n° HEALTH-F2-2010-260309 (PRESTIGE). Funding for open access publication is provided by the European Commission |
| Databáze: | OpenAIRE |
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