Clinical research
Interventional cardiology
Stent underexpansion and residual reference segment stenosis are related to stent thrombosis after sirolimus-eluting stent implantation: An intravascular ultrasound study

https://doi.org/10.1016/j.jacc.2004.12.066Get rights and content
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Objectives

We sought to determine the predictors of stent thrombosis after sirolimus-eluting stent (SES) implantation.

Background

A number of cases of stent thrombosis have been reported after commercial release of the SES in the “real world,” such that the U.S. Food and Drug Administration issued a warning.

Methods

Fifteen patients who developed stent thrombosis after successful SES implantation were analyzed and compared with 45 matched control patients who had no evidence of stent thrombosis.

Results

Minimum stent cross-sectional area (MSA) (4.3 ± 1.6 mm2vs. 6.2 ± 1.9 mm2, p < 0.001) and stent expansion (0.65 ± 0.18 vs. 0.85 ± 0.14, p < 0.001) were significantly smaller in the stent thrombosis group than in the matched control patients. There was no significant difference in the rate of SES malapposition between the groups. However, the presence of a significant residual reference segment stenosis was more common in the stent thrombosis group compared with the matched control group (67% vs. 9%, p < 0.001). Independent predictors of stent thrombosis were stent underexpansion (p = 0.03) and a significant residual reference segment stenosis (p = 0.02).

Conclusions

Stent underexpansion and residual reference segment stenosis are associated with stent thrombosis after successful SES implantation.

Abbreviations and acronyms

CSA
cross-sectional area
EEM
external elastic membrane
IVUS
intravascular ultrasound
MSA
minimum stent cross-sectional area
SES
sirolimus-eluting stent

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