Details

Autor(en) / Beteiligte

• Morofuji, Toru, MD
• Inaba, Shinji, MD
• Hitsumoto, Tatsuro, MD
• Takahashi, Kayo, MD
• Aisu, Hiroe, MD
• Higashi, Haruhiko, MD
• Saito, Makoto, MD
• Ohshima, Kiyotaka, MD
• Ikeda, Shuntaro, MD
• Hamada, Mareomi, MD
• Sumimoto, Takumi, MD

Titel

Usefulness of Intravascular Ultrasound for Predicting Risk of Intraprocedural Stent Thrombosis

Ist Teil von

• The American journal of cardiology, 2016-03, Vol.117 (6), p.918-925

Ort / Verlag

United States: Elsevier Inc

Erscheinungsjahr

2016

Quelle

MEDLINE

Beschreibungen/Notizen

• Intraprocedural stent thrombosis (IPST) is a rare complication of percutaneous coronary intervention that leads to poor outcomes; however, the factors contributing to IPST remain largely unknown. Accordingly, we used intravascular ultrasound (IVUS) to examine the lesion characteristics in patients with IPST. We retrospectively analyzed 1,504 consecutive stent-implanted lesions in 1,324 patients (326 with ST-segment elevation myocardial infarction [STEMI], 403 patients with non–ST-segment elevation acute coronary syndrome [NSTE-ACS], and 595 patients with stable angina). Of these, IPST occurred in 5 patients during percutaneous coronary intervention (0.4% per patient; 3 with STEMI, 2 with NSTE-ACS). The IVUS characteristics of plaques that developed IPST were compared with those of controls without the evidence of IPST (non-IPST; n = 15) who were matched by age, gender, lesion location, and clinical presentation (STEMI, NSTE-ACS, or stable angina). All 5 lesions that led to IPST had ruptured plaques with positive remodeling and attenuation. Plaque rupture was also observed in 40% of the non-IPST group. Multiple plaque ruptures in the culprit lesion were more common in the IPST group (80% vs 7%; p <0.01). The maximum cavity area was larger in the IPST group than in the non-IPST group having plaque rupture (4.6 mm2 [interquartile range, 4.3 to 6.5] vs 2.4 mm2 [1.8 to 2.9]; p <0.01). In conclusion, we found using IVUS that multiple plaque ruptures with larger cavities more often evolved into IPST.