Fuentes Lara, Gómez-Lara Josep, Salvatella Neus, Gonzalo Nieves, Hernández-Hernández Felipe, Fernández-Nofrerias Eduard, Sánchez-Recalde Ángel, Alfonso Fernando, Romaguera Rafael, Ferreiro José Luis, Roura Gerard, Teruel Luis, Gracida Montserrat, Marcano Ana Lucrecia, Gómez-Hospital Joan-Antoni, Cequier Ángel
Departamento de Cardiología Intervencionista, Hospital Universitari de Bellvitge, Institut d' Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.
Departamento de Cardiología Intervencionista, Hospital Universitari de Bellvitge, Institut d' Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.
Rev Esp Cardiol (Engl Ed). 2018 May;71(5):335-343. doi: 10.1016/j.rec.2017.08.001. Epub 2017 Sep 1.
Stent thrombosis (ST) is a life-threatening complication after stent implantation. Intravascular ultrasound is able to discern most causes of ST. The aim of this study was to compare intravascular ultrasound findings between bare-metal stents (BMS) and drug-eluting stents (DES) in patients with late (31 days to 1 year) or very late ST (> 1 year).
Of 250 consecutive patients with late or very late ST in 7 Spanish institutions, 114 patients (45.5% BMS and 54.5% DES) were imaged with intravascular ultrasound. Off-line intravascular ultrasound analysis was performed to assess malapposition, underexpansion, and neoatherosclerosis.
The median time from stent implantation to ST was 4.0 years with BMS and 3.4 years with DES (P = .04). Isolated malapposition was similarly observed in both groups (36.5% vs 46.8%; P = .18) but was numerically lower with BMS (26.6% vs 48.0%; P = .07) in patients with very late ST. Isolated underexpansion was similarly observed in both groups (13.5% vs 11.3%; P = .47). Isolated neoatherosclerosis occurred only in patients with very late ST and was more prevalent with BMS (22.9%) than with DES (6.0%); P = .02. At 2.9 years' follow-up, there were 0% and 6.9% cardiac deaths, respectively (P = .06) and recurrent ST occurred in 4.0% and 5.2% of patients, respectively (P = .60).
Malapposition was the most common finding in patients with late and very late ST and is more prevalent with DES in very late ST. In contrast, neoatherosclerosis was exclusively observed in patients with very late ST and mainly with BMS.
支架血栓形成（ST）是支架植入术后一种危及生命的并发症。血管内超声能够识别大多数ST的病因。本研究的目的是比较晚期（31天至1年）或极晚期ST（>1年）患者中裸金属支架（BMS）和药物洗脱支架（DES）的血管内超声检查结果。
在西班牙7家机构连续纳入的250例晚期或极晚期ST患者中，114例患者（45.5%为BMS，54.5%为DES）接受了血管内超声检查。进行离线血管内超声分析以评估贴壁不良、扩张不全和新生动脉粥样硬化。
BMS组从支架植入到发生ST的中位时间为4.0年，DES组为3.4年（P = 0.04）。两组中孤立性贴壁不良的发生率相似（36.5%对46.8%；P = 0.18），但在极晚期ST患者中，BMS组孤立性贴壁不良的发生率在数值上较低（26.6%对48.0%；P = 0.07）。两组中孤立性扩张不全的发生率相似（13.5%对11.3%；P = 0.47）。孤立性新生动脉粥样硬化仅发生在极晚期ST患者中，且在BMS组（22.9%）比DES组（6.0%）更常见；P = 0.02。在2.9年的随访中，心脏死亡发生率分别为0%和6.9%（P = 0.06），复发性ST分别发生在4.0%和5.2%的患者中（P = 0.60）。
贴壁不良是晚期和极晚期ST患者最常见的表现，在极晚期ST患者中DES更常见。相比之下，新生动脉粥样硬化仅在极晚期ST患者中观察到，且主要发生在BMS患者中。
