Intravascular ultrasound assessed incomplete stent apposition and stent fracture in stent thrombosis after bare metal versus drug-eluting stent treatment the Nordic Intravascular Ultrasound Study (NIVUS)

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• 作者：Petteri Kosonen ; Saila Vikman ; Lisette Okkels Jensen ; Jens Flensted Lassen ; Jan Harnek ; G?ran K. Olivecrona ; Andrejs Erglis ; Eigil Fossum ; Matti Niemel? ; Kari Kervinen ; Antti Ylitalo ; Mikko Pietil? ; Jens Aaroe ; Thomas Kellerth ; Kari Saunam?ki ; Per Thayssen ; Lars Hellsten ; Leif Thuesen ; Kari Niemel?
• 关键词：Stent thrombosis ; Drug eluting stents ; Bare metal stents ; Intravascular ultrasound
• 刊名：International Journal of Cardiology
• 出版年：2013
• 出版时间：30 September, 2013
• 年：2013
• 卷：168
• 期：2
• 页码：1010-1016
• 全文大小：662 K

文摘

Background

This prospective multicenter registry used intravascular ultrasound (IVUS) in patients with definite stent thrombosis (ST) to compare rates of incomplete stent apposition (ISA), stent fracture and stent expansion in patients treated with drug-eluting (DES) versus bare metal (BMS) stents. ST is a rare, but potential life threatening event after coronary stent implantation. The etiology seems to be multifactorial.

Methods

124 patients with definite ST were assessed by IVUS during the acute ST event. The study was conducted in 15 high-volume percutaneous coronary intervention -centers in the Nordic-Baltic countries.

Results

In early or late ST there were no differences in ISA between DES and BMS. In very late ST, ISA was a more frequent finding in DES than in BMS (52 % vs.16 % ; p = 0.005) and the maximum ISA area was larger in DES compared to BMS (1.1 ¡À 2.3 mm² vs. 0.1 ¡À 0.5 mm²; p = 0.004). Further, ISA was more prevalent in sirolimus-eluting than in paclitaxel-eluting stents (58 % vs. 37 % ; p = 0.02). Stent fractures were found both in DES (16 % ) and BMS (24 % ); p = 0.28, and not related to time of stent thrombosis occurrence. For stents with nominal diameters ¡Ý 2.75 mm, 38 % of the DES and 22 % of the BMS had a minimum stent area of less than 5 mm²; p = 0.14.

Conclusions

Very late stent thrombosis was more prevalent and associated with more extensive ISA in DES than in BMS treated patients. Stent fracture was a common finding in ST after DES and BMS implantation.