Previous pathologic, intravascular imaging, and clinical studies have investigated the association between adverse cardiac events and stent malapposition, including acute stent malapposition (ASM, that is detected at index procedure) and late stent malapposition (LSM, that is detected during follow-up) that can be further classified into late-persistent stent malapposition (LPSM, ASM that remains at follow-up) or late-acquired stent malapposition (LASM, newly developed stent malapposition at follow-up that was not present immediately after index stent implantation). ASM has not been associated with adverse cardiac events compared with non-ASM, even in lesions with large-sized malapposition. The clinical outcomes of LSM may depend on its subtype. The recent intravascular ultrasound studies with long-term follow-up have consistently demonstrated that LASM steadily increased the risk of thrombotic events in patients with first-generation drug-eluting stents (DESs). This association has not yet been identified in LPSM. Accordingly, it is reasonable that approaches to stent malapposition should be based on its relationship with clinical outcomes. ASM may be tolerable after successful stent implantation, whereas prolonged anti-thrombotic medications and/or percutaneous interventions to modify LASM may be considered in selected patients with first-generation DESs. However, these treatments are still questionable due to lack of firm evidences.
Bibliographical noteFunding Information:
This work was supported by grants from the Korea Health Technology Research & Development Project through the Korea Health Industry Development Institute, funded by the Ministry of Health & Welfare, Republic of Korea (No. HI17C0882, HI16C2211, and HI15C2782); the Bio & Medical Technology Development Program of the National Research Foundation funded by the Korean government (No. 2015M3A9C6031514); the Cardiovascular Research Center, Seoul, Korea; and the Wonkwang University in 2020.
All Science Journal Classification (ASJC) codes
- Internal Medicine
- Cardiology and Cardiovascular Medicine