Boeder Niklas F, Weissner Melissa, Blachutzik Florian, Ullrich Helen, Anadol Remzi, Tröbs Monique, Münzel Thomas, Hamm Christian W, Dijkstra Jouke, Achenbach Stephan, Nef Holger M, Gori Tommaso
Medical Clinic I, University Hospital of Giessen, Klinikstrasse 33, 35392 Giessen, Germany.
Zentrum für Kardiologie, University Hospital Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany and German Center for Cardiac and Vascular Research (DZHK), Standort Rhein-Main.
J Clin Med. 2019 Apr 27;8(5):580. doi: 10.3390/jcm8050580.
Malapposition is a common finding in stent and scaffold thrombosis (ScT). Evidence from studies with prospective follow-up, however, is scarce. We hypothesized that incidental observations of strut malapposition might be predictive of late ScT during subsequent follow-up. One hundred ninety-seven patients were enrolled in a multicentre registry with prospective follow-up. Optical coherence tomography (OCT), performed in an elective setting, was available in all at 353 (0-376) days after bioresorbable scaffold (BRS) implantation. Forty-four patients showed evidence of malapposition that was deemed not worthy of intervention. Malapposition was not associated with any clinical or procedural parameter except for a higher implantation pressure ( = 0.0008). OCT revealed that malapposition was associated with larger vessel size, less eccentricity (all < 0.01), and a tendency for more uncovered struts ( = 0.06). Late or very late ScT was recorded in seven of these patients 293 (38-579) days after OCT. OCT-diagnosed malapposition was a predictor of late and very late scaffold thrombosis ( < 0.001) that was independent of the timing of diagnosis. We provide evidence that an incidental finding of malapposition-regardless of the timing of diagnosis of the malapposition-during an elective exam is a predictor of late and very late ScT. Our data provide a rationale to consider prolonged dual antiplatelet therapy if strut malapposition is observed.
支架贴壁不良是支架和支架内血栓形成（ScT）的常见表现。然而，前瞻性随访研究的证据却很少。我们推测，支架贴壁不良的偶然发现可能预示着后续随访期间的晚期ScT。197例患者被纳入一项进行前瞻性随访的多中心注册研究。在生物可吸收支架（BRS）植入后353（0 - 376）天，所有患者均在择期情况下接受了光学相干断层扫描（OCT）检查。44例患者出现了被认为无需干预的贴壁不良证据。除植入压力较高外（ = 0.0008），贴壁不良与任何临床或手术参数均无关联。OCT显示，贴壁不良与血管直径较大、偏心度较小（均 < 0.01）以及未覆盖支架较多的趋势有关（ = 0.06）。在这些患者中，有7例在OCT检查后293（38 - 579）天发生了晚期或极晚期ScT。OCT诊断的贴壁不良是晚期和极晚期支架内血栓形成的预测因素（ < 0.001），且与诊断时间无关。我们提供的证据表明，在择期检查期间偶然发现的贴壁不良——无论贴壁不良的诊断时间如何——都是晚期和极晚期ScT的预测因素。我们的数据为在观察到支架贴壁不良时考虑延长双联抗血小板治疗提供了理论依据。
