Abstract
Lack of contact between stent struts and underlying vessel surface, described as stent malapposition, is observed more frequently after implantation of drug-eluting stent (DES) than that of bare-metal stent. Several studies have suggested the potential relationship between the stent malapposition and late stent thrombosis (LST). On the coronary angiography, stent malapposition is recognized as peri-stent staining (PSS) that is contrast staining outside of the stent contour. Intravascular imaging modalities, including intravascular ultrasound and optical coherence tomography, can detect less extensive stent malapposition by their high resolution and the ability to provide the cross-sectional images of the vessel. Coronary angioscopy, the intravascular imaging of a different dimension, permits the direct visualization of the intimal surface and provides an opportunity to understand pathogenesis and clinical implication of PSS. Pathological examination showed hypersensitivities mainly composed of inflammation at the site of stent malapposition. Coronary angioscopy shows yellow plaque and thrombus at PSS site, suggesting underlying inflammation and high thrombogenicity. These findings support the relation of PSS to LST. Careful medications, including dual antiplatelet therapy and intensive statin therapy, should be warranted for prevention of LST in patients with PSS.
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Dai, K., Ishihara, M. (2015). Peri-stent Contrast Staining. In: Mizuno, K., Takano, M. (eds) Coronary Angioscopy. Springer, Tokyo. https://doi.org/10.1007/978-4-431-55546-9_16
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DOI: https://doi.org/10.1007/978-4-431-55546-9_16
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