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Stent Thrombosis

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Abstract

The occurrence of stent thrombosis (ST) is rare but it remains one of the most dreadful complications following Percutaneous Coronary Intervention (PCI), due to the possible risk of death and extensive myocardial infarction. OCT contributes critically in the assessment of ST with substantial clinical implications through: (1) a better mechanistic understanding of the different processes involved; (2) the identification of surrogate markers anticipating the risk of ST; (3) a tailored and more effective approach for the acute treatment of ST. The high level of accuracy in the measurements and separation of the plaque and thrombus components along the entire vessel, and in the fine details on tissue coverage at the stent strut level, makes OCT a unique intracoronary imaging modality for assessing stent failures and guiding appropriate interventions during ST.

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References

  1. Stone GW, Ellis SG, Cox DA, Hermiller J, O'Shaughnessy C, Mann JT, et al.; TAXUS-IV Investigators. A polymer-based, paclitaxel-eluting stent in patients with coronary artery disease. N Engl J Med. 2004;350(3):221–31.

    Google Scholar 

  2. Moses JW, Leon MB, Popma JJ, Fitzgerald PJ, Holmes DR, O’Shaughnessy C, et al.; SIRIUS Investigators. Sirolimus-eluting stents versus standard stents in patients with stenosis in a native coronary artery. N Engl J Med. 2003;349(14):1315–23.

    Google Scholar 

  3. Kuchulakanti PK, Chu WW, Torguson R, Ohlmann P, Rha SW, Clavijo LC, et al. Correlates and long-term outcomes of angiographically proven stent thrombosis with sirolimus- and paclitaxel-eluting stents. Circulation. 2006;113(8):1108–13.

    Article  CAS  PubMed  Google Scholar 

  4. Daemen J, Wenaweser P, Tsuchida K, Abrecht L, Vaina S, Morger C, et al. Early and late coronary stent thrombosis of sirolimus-eluting and paclitaxel-eluting stents in routine clinical practice: data from a large two-institutional cohort study. Lancet. 2007;369(9562):667–78.

    Article  CAS  PubMed  Google Scholar 

  5. Cook S, Meier B. Have we been misled by the ESC DES firestorm? EuroIntervention. 2008;3(5):535–7.

    Article  PubMed  Google Scholar 

  6. Cutlip DE, Windecker S, Mehran R, Boam A, Cohen DJ, van Es GA, et al.; Academic Research Consortium. Clinical end points in coronary stent trials: a case for standardized definitions. Circulation. 2007;115(17):2344–51.

    Google Scholar 

  7. Serruys PW, Strauss BH, Beatt KJ, Bertrand ME, Puel J, Rickards AF, et al. Angiographic follow-up after placement of a self-expanding coronary-artery stent. N Engl J Med. 1991;324(1):13–7.

    Article  CAS  PubMed  Google Scholar 

  8. Colombo A, Hall P, Nakamura S, Almagor Y, Maiello L, Martini G, et al. Intracoronary stenting without anticoagulation accomplished with intravascular ultrasound guidance. Circulation. 1995;91(6):1676–88.

    Article  CAS  PubMed  Google Scholar 

  9. Karrillon GJ, Morice MC, Benveniste E, Bunouf P, Aubry P, Cattan S, et al. Intracoronary stent implantation without ultrasound guidance and with replacement of conventional anticoagulation by antiplatelet therapy. Circulation. 1996;94(7):1519–27.

    Article  CAS  PubMed  Google Scholar 

  10. Moussa I, Di Mario C, Reimers B, Akiyama T, Tobis J, Colombo A. Subacute stent thrombosis in the era of intravascular ultrasound-guided coronary stenting without anticoagulation: frequency, predictors and clinical outcome. J Am Coll Cardiol. 1997;29(1):6–12.

    Article  CAS  PubMed  Google Scholar 

  11. Schühlen H, Kastrati A, Dirschinger J, Hausleiter J, Elezi S, Wehinger A, et al. Intracoronary stenting and risk for major adverse cardiac events during the first month. Circulation. 1998;98(2):104–11.

    Article  PubMed  Google Scholar 

  12. De Servi S, Repetto S, Klugmann S, Bossi I, Colombo A, Piva R, et al. Stent thrombosis: incidence and related factors in the R.I.S.E. Registry (Registro Impianto Stent Endocoronarico). Catheter Cardiovasc Interv. 1999;46(1):13–8.

    Article  PubMed  Google Scholar 

  13. Cutlip DE, Baim DS, Ho KK, Popma JJ, Lansky AJ, Cohen DJ, Carrozza Jr JP, et al. Stent thrombosis in the modern era: a pooled analysis of multicenter coronary stent clinical trials. Circulation. 2001;103(15):1967–71.

    Article  CAS  PubMed  Google Scholar 

  14. Ong AT, Hoye A, Aoki J, van Mieghem CA, Rodriguez Granillo GA, Sonnenschein K, et al. Thirty-day incidence and six-month clinical outcome of thrombotic stent occlusion after bare-metal, sirolimus, or paclitaxel stent implantation. J Am Coll Cardiol. 2005;45(6):947–53.

    Article  CAS  PubMed  Google Scholar 

  15. van Werkum JW, Heestermans AA, de Korte FI, Kelder JC, Suttorp MJ, Rensing BJ, et al. Long – term clinical outcome after a first angiographically confirmed coronary stent thrombosis: an analysis of 431 cases. Circulation. 2009;119(6):828–34.

    Article  PubMed  Google Scholar 

  16. Wenaweser P, Daemen J, Zwahlen M, van Domburg R, Jüni P, Vaina S, et al. Incidence and correlates of drug-eluting stent thrombosis in routine clinical practice. 4-year results from a large 2-institutional cohort study. J Am Coll Cardiol. 2008;52(14):1134–40.

    Article  CAS  PubMed  Google Scholar 

  17. Moreno R, Fernández C, Hernández R, Alfonso F, Angiolillo DJ, Sabaté M, et al. Drug-eluting stent thrombosis: results from a pooled analysis including 10 randomized studies. J Am Coll Cardiol. 2005;45(6):954–9.

    Article  CAS  PubMed  Google Scholar 

  18. Kastrati A, Dibra A, Eberle S, Mehilli J, Suárez de Lezo J, Goy JJ, et al. Sirolimus-eluting stents vs paclitaxel-eluting stents in patients with coronary artery disease: meta-analysis of randomized trials. JAMA. 2005;294(7):819–25.

    Article  CAS  PubMed  Google Scholar 

  19. Sarno G, Lagerqvist B, Fröbert O, Nilsson J, Olivecrona G, Omerovic E, et al. Lower risk of stent thrombosis and restenosis with unrestricted use of ‘new-generation’ drug-eluting stents: a report from the nationwide Swedish Coronary Angiography and Angioplasty Registry (SCAAR). Eur Heart J. 2012;33(5):606–13.

    Article  PubMed  Google Scholar 

  20. Palmerini T, Kirtane AJ, Serruys PW, Smits PC, Kedhi E, Kereiakes D, et al. Stent thrombosis with everolimus-eluting stents: meta-analysis of comparative randomized controlled trials. Circ Cardiovasc Interv. 2012;5(3):357–64.

    Article  CAS  PubMed  Google Scholar 

  21. Holmes Jr DR, Kereiakes DJ, Garg S, Serruys PW, Dehmer GJ, Ellis SG, et al. Stent thrombosis. J Am Coll Cardiol. 2010;56(17):1357–65.

    Article  PubMed  Google Scholar 

  22. Iakovou I, Schmidt T, Bonizzoni E, Sangiorgi GM, Stankovic G, Airoldi F, et al. Incidence, predictors, and outcome of thrombosis after successful implantation of drug-eluting stents. JAMA. 2005;293(17):2126–30.

    Article  CAS  PubMed  Google Scholar 

  23. van Werkum JW, Heestermans AA, Zomer AC, Kelder JC, Suttorp MJ, Rensing BJ, et al. Predictors of coronary stent thrombosis: the Dutch Stent Thrombosis Registry. J Am Coll Cardiol. 2009;53(16):1399–409.

    Article  PubMed  Google Scholar 

  24. Kohn CG, Kluger J, Azeem M, Coleman CI. Short-term consequences of angiographically-confirmed coronary stent thrombosis. PLoS One. 2013;8(10):e77330.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  25. Parodi G, Memisha G, Bellandi B, Valenti R, Migliorini A, Carrabba N, et al. Effectiveness of primary percutaneous coronary interventions for stent thrombosis. Am J Cardiol. 2009;103(7):913–6.

    Article  PubMed  Google Scholar 

  26. Chechi T, Vecchio S, Vittori G, Giuliani G, Lilli A, Spaziani G, et al. ST-segment elevation myocardial infarction due to early and late stent thrombosis a new group of high-risk patients. J Am Coll Cardiol. 2008;51(25):2396–402.

    Article  PubMed  Google Scholar 

  27. Parodi G, Marcucci R, Valenti R, Gori AM, Migliorini A, Giusti B, et al. High residual platelet reactivity after clopidogrel loading and long-term cardiovascular events among patients with acute coronary syndromes undergoing PCI. JAMA. 2011;306(11):1215–23.

    Article  CAS  PubMed  Google Scholar 

  28. Rinaldi MJ, Kirtane AJ, Piana RN, Caputo RP, Gordon PC, Lopez JJ, et al. Clinical, procedural, and pharmacologic correlates of acute and subacute stent thrombosis: results of a multicenter case-control study with 145 thrombosis events. Am Heart J. 2008;155(4):654–60.

    Article  CAS  PubMed  Google Scholar 

  29. de la Torre-Hernández JM, Alfonso F, Hernández F, Elizaga J, Sanmartin M, Pinar E, et al. ESTROFA Study Group. Drug-eluting stent thrombosis: results from the multicenter Spanish registry ESTROFA (Estudio ESpanol sobre TROmbosis de stents FArmacoactivos). J Am Coll Cardiol. 2008;51(10):986–90.

    Article  PubMed  Google Scholar 

  30. Roy P, Torguson R, Okabe T, Pinto Slottow TL, Steinberg DH, Smith K, et al. Angiographic and procedural correlates of stent thrombosis after intracoronary implantation of drug-eluting stents. J Interv Cardiol. 2007;20(5):307–13.

    Article  PubMed  Google Scholar 

  31. Park DW, Park SW, Park KH, Lee BK, Kim YH, Lee CW, et al. Frequency of and risk factors for stent thrombosis after drug-eluting stent implantation during long-term follow-up. Am J Cardiol. 2006;98(3):352–6.

    Article  PubMed  Google Scholar 

  32. Pinto Slottow TL, Bonello L, Gavini R, Beauzile P, Sushinsky SJ, Scheinowitz M, et al. Prevalence of aspirin and clopidogrel resistance among patients with and without drug-eluting stent thrombosis. Am J Cardiol. 2009;104(4):525–30.

    Article  CAS  PubMed  Google Scholar 

  33. Gurbel PA, Bliden KP, Samara W, Yoho JA, Hayes K, Fissha MZ, et al. Clopidogrel effect on platelet reactivity in patients with stent thrombosis: results of the CREST Study. J Am Coll Cardiol. 2005;46(10):1827–32.

    Article  CAS  PubMed  Google Scholar 

  34. Nakano M, Yahagi K, Otsuka F, Sakakura K, Finn AV, Kutys R, et al. Causes of early stent thrombosis in patients presenting with acute coronary syndrome: an ex vivo human autopsy study. J Am Coll Cardiol. 2014;63(23):2510–20.

    Article  PubMed  Google Scholar 

  35. Virmani R, Guagliumi G, Farb A, Musumeci G, Grieco N, Motta T, et al. Localized hypersensitivity and late coronary thrombosis secondary to a sirolimus-eluting stent: should we be cautious? Circulation. 2004;109(6):701–5.

    Article  PubMed  Google Scholar 

  36. Nebeker JR, Virmani R, Bennett CL, Hoffman JM, Samore MH, Alvarez J, et al. Hypersensitivity cases associated with drug-eluting coronary stents: a review of available cases from the Research on Adverse Drug Events and Reports (RADAR) project. J Am Coll Cardiol. 2006;47(1):175–81.

    Article  PubMed  Google Scholar 

  37. Joner M, Finn AV, Farb A, Mont EK, Kolodgie FD, Ladich E, et al. Pathology of drug-eluting stents in humans: delayed healing and late thrombotic risk. J Am Coll Cardiol. 2006;48(1):193–202.

    Article  PubMed  Google Scholar 

  38. Cook S, Ladich E, Nakazawa G, Eshtehardi P, Neidhart M, Vogel R, et al. Correlation of intravascular ultrasound findings with histopathological analysis of thrombus aspirates in patients with very late drug-eluting stent thrombosis. Circulation. 2009;120(5):391–9.

    Article  PubMed  Google Scholar 

  39. Park SJ, Kang SJ, Virmani R, Nakano M, Ueda Y. In-stent neoatherosclerosis: a final common pathway of late stent failure. J Am Coll Cardiol. 2012;59(23):2051–77.

    Article  PubMed  Google Scholar 

  40. Nakazawa G, Otsuka F, Nakano M, Vorpahl M, Yazdani SK, Ladich E, et al. The pathology of neoatherosclerosis in human coronary implants bare-metal and drug-eluting stents. J Am Coll Cardiol. 2011;57(11):1314–22.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  41. Mintz GS. Clinical utility of intravascular imaging and physiology in coronary artery disease. J Am Coll Cardiol. 2014;64(2):207–22.

    Article  PubMed  Google Scholar 

  42. Prati F, Guagliumi G, Mintz GS, Costa M, Regar E, Akasaka T, et al. Expert review document part 2: methodology, terminology and clinical applications of optical coherence tomography for the assessment of interventional procedures. Expert’s OCT Review Document. Eur Heart J. 2012;33(20):2513–20.

    Article  PubMed Central  PubMed  Google Scholar 

  43. Guagliumi G, Sirbu V, Musumeci G, Gerber R, Biondi-Zoccai G, Ikejima H, et al. Examination of the in vivo mechanisms of late drug-eluting stent thrombosis: findings from optical coherence tomography and intravascular ultrasound imaging. JACC Cardiovasc Interv. 2012;5(1):12–20.

    Article  PubMed  Google Scholar 

  44. Kang SJ, Lee CW, Song H, Ahn JM, Kim WJ, Lee JY, et al. OCT analysis in patients with very late stent thrombosis. JACC Cardiovasc Imaging. 2013;6(6):695–703.

    Article  PubMed  Google Scholar 

  45. Parodi G, La Manna A, Di Vito L, Valgimigli M, Fineschi M, et al. Stent-related defects in patients presenting with stent thrombosis: differences at optical coherence tomography between subacute and late/very late thrombosis in the Mechanism Of Stent Thrombosis (MOST) study. EuroIntervention. 2013;9(8):936–44.

    PubMed  Google Scholar 

  46. Cook S, Wenaweser P, Togni M, Billinger M, Morger C, Seiler C, et al. Incomplete stent apposition and very late stent thrombosis after drug-eluting stent implantation. Circulation. 2007;115(18):2426–34.

    Article  CAS  PubMed  Google Scholar 

  47. Gutiérrez-Chico JL, Wykrzykowska J, Nüesch E, van Geuns RJ, Koch KT, Koolen JJ, et al. Vascular tissue reaction to acute malapposition in human coronary arteries: sequential assessment with optical coherence tomography. Circ Cardiovasc Interv. 2012;5(1):20–9.

    Article  PubMed  Google Scholar 

  48. Malle C, Tada T, Steigerwald K, Ughi GJ, Schuster T, Nakano M, et al. Tissue characterization after drug-eluting stent implantation using optical coherence tomography. Arterioscler Thromb Vasc Biol. 2013;33(6):1376–83.

    Article  CAS  PubMed  Google Scholar 

  49. Nakano M, Vorpahl M, Otsuka F, Taniwaki M, Yazdani SK, Finn AV, et al. Ex vivo assessment of vascular response to coronary stents by optical frequency domain imaging. JACC Cardiovasc Imaging. 2012;5(1):71–82.

    Article  PubMed  Google Scholar 

  50. Guagliumi G, Costa MA, Sirbu V, Musumeci G, Bezerra HG, Suzuki N, et al. Strut coverage and late malapposition with paclitaxel-eluting stents compared with bare metal stents in acute myocardial infarction: optical coherence tomography substudy of the Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI) Trial. Circulation. 2011;123(3):274–81.

    Article  CAS  PubMed  Google Scholar 

  51. Zwart B, van Werkum JW, Heestermans AA, Kelder JC, Zomer AC, van’t Hof AW, et al. Triggering mechanisms of stent thrombosis. EuroIntervention. 2011;6(6):722–8.

    Article  PubMed  Google Scholar 

  52. Lüscher TF, Steffel J, Eberli FR, Joner M, Nakazawa G, Tanner FC, et al. Drug-eluting stent and coronary thrombosis: biological mechanisms and clinical implications. Circulation. 2007;115(8):1051–8.

    Article  PubMed  Google Scholar 

  53. Higo T, Ueda Y, Oyabu J, Okada K, Nishio M, Hirata A, et al. Atherosclerotic and thrombogenic neointima formed over sirolimus drug-eluting stent: an angioscopic study. JACC Cardiovasc Imaging. 2009;2(5):616–24.

    Article  PubMed  Google Scholar 

  54. Takano M, Yamamoto M, Inami S, Murakami D, Ohba T, Seino Y, et al. Comparison of incidence and time course of neoatherosclerosis between bare metal stents and drug-eluting stents using optical coherence tomography. J Am Coll Cardiol. 2009;55(1):26–32.

    Article  PubMed  Google Scholar 

  55. Yonetsu T, Kim JS, Kato K, Kim SJ, Xing L, Yeh RW, et al. Comparison of incidence and time course of neoatherosclerosis between bare metal stents and drug-eluting stents using optical coherence tomography. Am J Cardiol. 2012;110(7):933–9.

    Article  CAS  PubMed  Google Scholar 

  56. Otsuka F, Vorpahl M, Nakano M, et al. Pathology of second-generation everolimus-eluting stents versus first-generation sirolimus- and paclitaxel-eluting stents in humans. Circulation 2014;129:211–23.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Cardiovascular Department, A.O. Papa Giovanni XXIII Hospital, Piazza OMS 1, Bergamo, 24127, Italy

    Giulio Guagliumi MD, FESC, Chiara Bernelli MD, Kenichi Komukai MD & Vasile Sirbu MD

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  1. Giulio Guagliumi MD, FESC
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  2. Chiara Bernelli MD
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  3. Kenichi Komukai MD
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  4. Vasile Sirbu MD
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Correspondence to Giulio Guagliumi MD, FESC .

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  1. Massachusetts General Hospital Harvard Medical School, Boston, Massachusetts, USA

    Ik-Kyung Jang

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Guagliumi, G., Bernelli, C., Komukai, K., Sirbu, V. (2015). Stent Thrombosis. In: Jang, IK. (eds) Cardiovascular OCT Imaging. Springer, Cham. https://doi.org/10.1007/978-3-319-10801-8_11

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  • DOI: https://doi.org/10.1007/978-3-319-10801-8_11

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