Université d'Auvergne Clermont1 | CNRS

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Mechanisms of stent thrombosis analysed by optical coherence tomography: insights from the national PESTO French registry.

TitleMechanisms of stent thrombosis analysed by optical coherence tomography: insights from the national PESTO French registry.
Publication TypeJournal Article
Year of Publication2016
AuthorsSouteyrand, G., N. Amabile, L. Mangin, X. Chabin, N. Meneveau, G. Cayla, G. Vanzetto, P. Barnay, C. Trouillet, G. Rioufol, G. Rangé, E. Teiger, R. Delaunay, O. Dubreuil, T. Lhermusier, A. Mulliez, S. Levesque, L. Belle, C. Caussin, and P. Motreff
Corporate AuthorsPESTO Investigators
JournalEuropean heart journal
Date Published2016 Jan 12
ISSN1522-9645
Abstract

AIMS: Angiography has limited value for identifying the causes of stent thrombosis (ST). We studied a large cohort of patients by optical coherence tomography (OCT) to explore ST characteristics and mechanisms.

METHODS AND RESULTS: A prospective multicentre registry was screened for patients with confirmed ST. Optical coherence tomography was performed after initial intervention to the culprit lesion (in 69% of cases in a deferred procedure). Stent thrombosis was classified as acute (AST), sub-acute (SAST), late (LST), and very late (VLST). Optical coherence tomography records were analysed in a central core lab. The analysis included 120 subjects aged 61.7 [51.4-70.7]; 89% male. Very late ST was the clinical presentation in 75%, LST in 6%, SAST in 15%, and AST in 4% of patients. Bare metal stents (BMS) were used in 39%, drug-eluting stents (DES) in 59% and bioresorbable vascular scaffolds in 2% of the cases. Optical coherence tomography identified an underlying morphological abnormality in 97% of cases, including struts malapposition (34%), neoatherosclerotic lesions (22%), major stent underexpansion (11%), coronary evagination (8%), isolated uncovered struts (8%), edge-related disease progression (8%), and neointimal hyperplasia (4%). Ruptured neoatherosclerotic lesions were more frequent with BMS than with DES (36 vs. 14%, P = 0.005), whereas coronary evaginations were more frequent with DES than with BMS (12 vs. 2%, P = 0.04). LST + VLST were mainly related to malapposition (31%) and neoatherosclerosis (28%), while prominent mechanisms for AST + SAST were malapposition (48%) and underexpansion (26%).

CONCLUSION: In patients with confirmed ST, OCT imaging identified an underlying morphological abnormality in 97% of cases.

DOI10.1093/eurheartj/ehv711
Alternate JournalEur. Heart J.