Characteristics of earlier versus delayed presentation of very late drug-eluting stent thrombosis: An optical coherence tomographic study

Seung Yul Lee, Jung Min Ahn, Gary S. Mintz, Seung Ho Hur, So Yeon Choi, Sang Wook Kim, Jin Man Cho, Soon Jun Hong, Jin Won Kim, Young Joon Hong, Sang Gon Lee, Dong Ho Shin, Jung Sun Kim, Byeong Keuk Kim, Young Guk Ko, Donghoon Choi, Yangsoo Jang, Seung Jung Park, Myeong Ki Hong

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14 Citations (Scopus)


Background-—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. Methods and Results-—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; P=0.019). Conversely, the frequency of neoatherosclerosis was higher in patients with delayed versus earlier VLST (44.9% versus 24.5%, respectively; P=0.034). The frequency of stent malapposition was not different between patients with earlier and delayed VLST (34.7% versus 32.7%, respectively; P=0.831). The frequency of stent malapposition, evagination, and uncovered struts was still half of delayed VLST. Conclusions-—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.

Original languageEnglish
Article numbere005386
JournalJournal of the American Heart Association
Issue number4
Publication statusPublished - 2017

Bibliographical note

Funding Information:
This study was supported by a grant from the Korea Healthcare Technology Research and Development Project, Ministry for Health and Welfare, Republic of Korea (A085136 and HI15C1277); the National Research Foundation of Korea (NRF) grant funded by the Korea government (MEST), Republic of Korea (2015R1A2A2A01002731); and the Cardiovascular Research Center, Seoul, Korea.

Publisher Copyright:
© 2017 The Authors.

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine


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