Lee Seung-Yul, Ahn Jung-Min, Mintz Gary S, Hur Seung-Ho, Choi So-Yeon, Kim Sang-Wook, Cho Jin Man, Hong Soon Jun, Kim Jin Won, Hong Young Joon, Lee Sang-Gon, Shin Dong-Ho, Kim Jung-Sun, Kim Byeong-Keuk, Ko Young-Guk, Choi Donghoon, Jang Yangsoo, Park Seung-Jung, Hong Myeong-Ki
Department of Internal Medicine, Sanbon Hospital, Wonkwang University College of Medicine, Gunpo, Korea.
Department of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan, Seoul, Korea.
J Am Heart Assoc. 2017 Apr 14;6(4):e005386. doi: 10.1161/JAHA.116.005386.
The pathophysiology underlying very late drug-eluting stent (DES) thrombosis is not sufficiently understood. Using optical coherence tomography, we investigated characteristics of very late stent thrombosis (VLST) according to different onset times.
A total of 98 patients from 10 South Korean hospitals who underwent optical coherence tomography for evaluation of very late DES thrombosis were retrospectively included in analyses. VLST occurred at a median of 55.1 months after DES implantation. All patients were divided into 2 equal groups of earlier versus delayed presentation of VLST, according to median onset time. In total, 27 patients were treated with next-generation DES and 71 with first-generation DES. Based on optical coherence tomography findings at thrombotic sites, main VLST mechanisms were as follows, in descending order: neoatherosclerosis (34.7%), stent malapposition (33.7%), and uncovered struts without stent malapposition or evagination (24.5%). Compared with patients with earlier VLST, patients with delayed VLST had lower frequency of uncovered struts without stent malapposition or evagination (34.7% versus 14.3%, respectively; =0.019). Conversely, the frequency of neoatherosclerosis was higher in patients with delayed versus earlier VLST (44.9% versus 24.5%, respectively; =0.034). The frequency of stent malapposition was not different between patients with earlier and delayed VLST (34.7% versus 32.7%, respectively; =0.831). The frequency of stent malapposition, evagination, and uncovered struts was still half of delayed VLST.
The pathological mechanisms of very late DES thrombosis changed over time. Delayed neointimal healing remained a substantial substrate for VLST, even long after DES implantation.
极晚期药物洗脱支架（DES）血栓形成的病理生理学尚未得到充分理解。我们使用光学相干断层扫描技术，根据不同的发病时间研究了极晚期支架血栓形成（VLST）的特征。
对来自韩国10家医院的98例接受光学相干断层扫描以评估极晚期DES血栓形成的患者进行回顾性分析。VLST发生在DES植入后的中位时间为55.1个月。根据中位发病时间，所有患者被分为VLST早期出现组和延迟出现组，每组人数相等。共有27例患者接受了新一代DES治疗，71例接受了第一代DES治疗。根据血栓形成部位的光学相干断层扫描结果，主要的VLST机制如下，按降序排列：新生动脉粥样硬化（34.7%）、支架贴壁不良（33.7%）以及无支架贴壁不良或外翻的裸支架（24.5%）。与VLST早期出现的患者相比，VLST延迟出现的患者无支架贴壁不良或外翻的裸支架频率较低（分别为34.7%和14.3%；P=0.019）。相反，VLST延迟出现的患者新生动脉粥样硬化的频率高于早期出现的患者（分别为44.9%和24.5%；P=0.034）。VLST早期出现和延迟出现的患者之间支架贴壁不良的频率没有差异（分别为34.7%和32.7%；P=0.831）。支架贴壁不良、外翻和裸支架的频率仍为VLST延迟出现情况的一半。
极晚期DES血栓形成的病理机制随时间而变化。即使在DES植入后很长时间，延迟的内膜愈合仍然是VLST的一个重要基础。
