医学
病因学
支架
经皮冠状动脉介入治疗
光学相干层析成像
放射科
冠状动脉疾病
病变
新生内膜
内科学
心脏病学
外科
再狭窄
心肌梗塞
作者
Hiroyoshi Mori,Teruo Sekimoto,Taito Arai,Rikuo Sakai,S Sato,Takahiro Tezuka,Ayumi Omura,Toshiro Shinke,Hiroshi Suzuki
标识
DOI:10.1016/j.cjca.2023.11.034
摘要
Background Although VLST remains an important concern, the underlying etiology and clinical characteristics are not fully elucidated in Japanese patients who undergo intravascular imaging-guided percutaneous coronary intervention (PCI) regularly. Methods We identified 50 VLST lesions (BMS [n=16], 1ST generation DES [n=14] and newer generation DES [n=20]) in patients managed in our institutes. The underlying mechanism of VLST was assessed by optical coherence tomography (OCT), and the major etiology of each lesion was determined. The aim of this study was to explore the mechanisms of very late stent thrombosis (VLST) of bare metal stents (BMSs) and drug-eluting stents (DESs) in Japanese patients. Results The median duration since stent implantation was 10 years (range 1–20). The most frequent etiology of VLST was neoatherosclerotic rupture (44%), followed by neointimal erosion (24%). Edge disease (10%) and evagination (10%) were similarly observed. Malapposition (8%) was deemed to be acquired late by looking at intravascular imaging from the index procedure. Uncovered struts (2%) and in-stent calcified nodule (2%) were the least frequent etiologies. Regardless of etiology, signs of neoatherosclerosis were present in most lesions (82%). Most patients received single (68%) or dual (8%) antiplatelet therapy or oral anticoagulation alone (4%), whereas a considerable proportion of patients discontinued medication (20%). Regarding the treatment strategy, drug-coated balloon was the most frequent strategy (56%), followed by newer DES implantation (34%). Conclusion Various mechanisms have been identified in Japanese VLST patients. In these patients, biological responses seemed to be more relevant than the index procedure-related factors.
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