ABSTRACT
Although the safety profiles of coronary stents eluting sirolimus or paclitaxel do not seem to differ from those of bare metal stents in the short-to-medium term, concern has arisen about the potential for late stent thromboses related to delayed endothelialisation of the stent struts. We report four cases of angiographically-confirmed stent thrombosis that occurred late after elective implantation of polymer-based paxlitaxel-eluting (343 and 442 days) or sirolimus-eluting (335 and 375 days) stents, and resulted in myocardial infarction. All cases arose soon after antiplatelet therapy was interrupted. If confirmed in systematic long-term follow-up studies, our findings have potentially serious clinical implications.
Subject(s)
Coronary Thrombosis/etiology , Paclitaxel/administration & dosage , Platelet Aggregation Inhibitors/therapeutic use , Sirolimus/administration & dosage , Stents/adverse effects , Aged , Angioplasty, Balloon, Coronary , Coronary Disease/therapy , Coronary Vessels , Humans , Male , Middle Aged , Myocardial Infarction/etiologyABSTRACT
Late stent thrombosis (> 30 days after treatment) is a new phenomenon occurring after vascular brachytherapy. We report the analysis of 11 patients with late thrombosis after gamma-irradiation treatment of in-stent restenosis. All patients had in-stent restenosis and angina. Contributing factors to late thrombosis include long stents, small distal vessels, and complex lesion morphology.
Subject(s)
Angioplasty, Balloon, Coronary/adverse effects , Brachytherapy/adverse effects , Coronary Restenosis/radiotherapy , Coronary Stenosis/therapy , Coronary Thrombosis/etiology , Stents/adverse effects , Aged , Angioplasty, Balloon, Coronary/methods , Brachytherapy/methods , Coronary Angiography , Coronary Stenosis/diagnostic imaging , Coronary Thrombosis/diagnostic imaging , Female , Follow-Up Studies , Humans , Male , Middle Aged , Risk Assessment , Sampling Studies , Severity of Illness Index , Time Factors , Ultrasonography, Interventional/methodsABSTRACT
OBJECTIVES: This study was designed to report the clinical and angiographic correlates of plaque rupture detected by intravascular ultrasound (IVUS). BACKGROUND: Acute coronary syndromes result from spontaneous plaque rupture and thrombosis. METHODS: We report 300 plaque ruptures in 257 arteries in 254 patients. Plaque ruptures were detected during pre-intervention IVUS. Standard clinical, angiographic, and IVUS parameters were collected and/or measured. One lesion per patient was analyzed. RESULTS: Multiple ruptures were observed in 39 of 254 patients (15%), 36 in the same artery. Plaque rupture occurred not only in patients with unstable angina (46%) or myocardial infarction (MI, 33%), but also stable angina (11%) or no symptoms (11%). The tear in the fibrous cap could be identified in 157 of 254 patients; 63% occurred at the shoulder of the plaque and 37% in the center of the plaque. Thrombi were more common in patients with unstable angina or MI (p = 0.02) and in multiple ruptures (p = 0.04). The plaque rupture site contained the minimum lumen area (MLA) site in only 28% of patients; rupture sites had larger arterial and lumen areas and more positive remodeling than MLA sites. Intravascular ultrasound plaque rupture strongly correlated with complex angiographic lesion morphology: ulceration in 81%, intimal flap in 40%, thrombus in 7%, and aneurysm in 7%. CONCLUSIONS: Plaque ruptures occur with varying clinical presentations, strongly correlate with angiographic complex lesion morphology, may be multiple, and usually do not cause lumen compromise.