Key Points
-
Stent thrombosis is a rare, but serious, complication of percutaneous coronary intervention and is associated with severe morbidity and mortality
-
Intravascular imaging has furthered our understanding of the mechanisms underlying stent thrombosis
-
Stent underexpansion and malapposition can be assessed and optimized at the time of stent implantation with the use of intravascular imaging
-
During follow-up imaging, strut coverage and neoatherosclerosis are best evaluated in vivo using optical coherence tomography
-
Optical coherence tomography might be particularly useful during evaluation of stent thrombosis events to determine specific underlying mechanisms and to guide therapy
-
Intravascular imaging has been crucial to the development and assessment of new bioresorbable stent technologies, although the risk of stent thrombosis associated with these devices requires further investigation
Abstract
Stent thrombosis is a rare, but serious, complication of percutaneous coronary intervention and is associated with severe morbidity and mortality. In addition to clinical and pathological studies, intravascular imaging has advanced our understanding of the mechanisms underlying stent thrombosis. In particular, intravascular imaging has been used to study stent underexpansion, malapposition, uncovered struts, and neoatherosclerosis as risk factors for stent thrombosis. Intravascular ultrasonography and optical coherence tomography can be used to guide stent implantation and minimize the risk of stent thrombosis. Additionally, optical coherence tomography offers the unique potential to tailor treatment of stent thrombosis to address the specific mechanism underlying the thrombotic event. Bioresorbable stent technologies have been introduced with the goal of further reducing the incidence of stent thrombosis, and intravascular imaging has had an integral role in the development and assessment of these new devices. In this Review, we present insights gained through intravascular imaging into the causes of stent thrombosis, and the potential utility of intravascular imaging in the optimization of stent deployment and treatment of stent thrombosis events.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$209.00 per year
only $17.42 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
References
Sigwart, U., Puel, J., Mirkovitch, V., Joffre, F. & Kappenberger, L. Intravascular stents to prevent occlusion and restenosis after transluminal angioplasty. N. Engl. J. Med. 316, 701–706 (1987).
Roguin, A. Stent: the man and word behind the coronary metal prosthesis. Circ. Cardiovasc. Interv. 4, 206–209 (2011).
Serruys, P. W. et al. Angiographic follow-up after placement of a self-expanding coronary-artery stent. N. Engl. J. Med. 324, 13–17 (1991).
Colombo, A. et al. Intracoronary stenting without anticoagulation accomplished with intravascular ultrasound guidance. Circulation 91, 1676–1688 (1995).
Serruys, P. W. et al. A comparison of balloon-expandable-stent implantation with balloon angioplasty in patients with coronary artery disease. Benestent Study Group. N. Engl. J. Med. 331, 489–495 (1994).
Fischman, D. L. et al. A randomized comparison of coronary-stent placement and balloon angioplasty in the treatment of coronary artery disease. Stent Restenosis Study Investigators. N. Engl. J. Med. 331, 496–501 (1994).
Morice, M. C. et al. A randomized comparison of a sirolimus-eluting stent with a standard stent for coronary revascularization. N. Engl. J. Med. 346, 1773–1780 (2002).
Grube, E. et al. TAXUS I: six- and twelve-month results from a randomized, double-blind trial on a slow-release paclitaxel-eluting stent for de novo coronary lesions. Circulation 107, 38–42 (2003).
Moses, J. W. et al. Sirolimus-eluting stents versus standard stents in patients with stenosis in a native coronary artery. N. Engl. J. Med. 349, 1315–1323 (2003).
Stone, G. W. et al. A polymer-based, paclitaxel-eluting stent in patients with coronary artery disease. N. Engl. J. Med. 350, 221–231 (2004).
Muni, N. I. & Gross, T. P. Problems with drug-eluting coronary stents—the FDA perspective. N. Engl. J. Med. 351, 1593–1595 (2004).
Moreno, R. et al. Drug-eluting stent thrombosis: results from a pooled analysis including 10 randomized studies. J. Am. Coll. Cardiol. 45, 954–959 (2005).
Bavry, A. A., Kumbhani, D. J., Helton, T. J. & Bhatt, D. L. What is the risk of stent thrombosis associated with the use of paclitaxel-eluting stents for percutaneous coronary intervention? A meta-analysis. J. Am. Coll. Cardiol. 45, 941–946 (2005).
Iakovou, I. et al. Incidence, predictors, and outcome of thrombosis after successful implantation of drug-eluting stents. JAMA 293, 2126–2130 (2005).
Ong, A. T. et al. Thirty-day incidence and six-month clinical outcome of thrombotic stent occlusion after bare-metal, sirolimus, or paclitaxel stent implantation. J. Am. Coll. Cardiol. 45, 947–953 (2005).
Wenaweser, P. et al. Incidence and correlates of drug-eluting stent thrombosis in routine clinical practice. 4-year results from a large 2-institutional cohort study. J. Am. Coll. Cardiol. 52, 1134–1140 (2008).
Stone, G. W. et al. Safety and efficacy of sirolimus- and paclitaxel-eluting coronary stents. N. Engl. J. Med. 356, 998–1008 (2007).
Lagerqvist, B. et al. Long-term outcomes with drug-eluting stents versus bare-metal stents in Sweden. N. Engl. J. Med. 356, 1009–1019 (2007).
Eisenstein, E. L. et al. Clopidogrel use and long-term clinical outcomes after drug-eluting stent implantation. JAMA 297, 159–168 (2007).
King, S. B. et al. 2007 focused update of the ACC/AHA/SCAI 2005 guideline update for percutaneous coronary intervention: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines: 2007 Writing Group to Review New Evidence and Update the ACC/AHA/SCAI 2005 guideline update for percutaneous coronary intervention, writing on behalf of the 2005 Writing Committee. Circulation 117, 261–295 (2008).
Wijns, W. et al. Guidelines on myocardial revascularization. Eur. Heart J. 31, 2501–2555 (2010).
Windecker, S. et al. 2014 ESC/EACTS guidelines on myocardial revascularization: the Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS): developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur. Heart J. 35, 2541–2619 (2014).
Cutlip, D. E. et al. Clinical end points in coronary stent trials: a case for standardized definitions. Circulation 115, 2344–2351 (2007).
Mauri, L. et al. Stent thrombosis in randomized clinical trials of drug-eluting stents. N. Engl. J. Med. 356, 1020–1029 (2007).
Stettler, C. et al. Outcomes associated with drug-eluting and bare-metal stents: a collaborative network meta-analysis. Lancet 370, 937–948 (2007).
Tada, T. et al. Risk of stent thrombosis among bare-metal stents, first-generation drug-eluting stents, and second-generation drug-eluting stents: results from a registry of 18,334 patients. JACC Cardiovasc. Interv. 6, 1267–1274 (2013).
Cutlip, D. E. et al. Stent thrombosis in the modern era: a pooled analysis of multicenter coronary stent clinical trials. Circulation 103, 967–1971 (2001).
Armstrong, E. J. et al. Clinical presentation, management, and outcomes of angiographically documented early, late, and very late stent thrombosis. JACC Cardiovasc. Interv. 5, 131–140 (2012).
Brodie, B. et al. Predictors of early, late, and very late stent thrombosis after primary percutaneous coronary intervention with bare-metal and drug-eluting stents for ST-segment elevation myocardial infarction. JACC Cardiovasc. Interv. 5, 1043–1051 (2012).
Uren, N. G. et al. Predictors and outcomes of stent thrombosis: an intravascular ultrasound registry. Eur. Heart J. 23, 124–132 (2002).
Schiele, F. et al. Impact of intravascular ultrasound guidance in stent deployment on 6-month restenosis rate: a multicenter, randomized study comparing two strategies—with and without intravascular ultrasound guidance. RESIST Study Group. REStenosis after Ivus guided STenting. J. Am. Coll. Cardiol. 32, 320–328 (1998).
Oemrawsingh, P. V. et al. Intravascular ultrasound guidance improves angiographic and clinical outcome of stent implantation for long coronary artery stenoses: final results of a randomized comparison with angiographic guidance (TULIP study). Circulation 107, 62–67 (2003).
Cook, S. et al. Incomplete stent apposition and very late stent thrombosis after drug-eluting stent implantation. Circulation 115, 2426–2434 (2007).
Russo, R. J. et al. A randomized controlled trial of angiography versus intravascular ultrasound-directed bare-metal coronary stent placement (the AVID trial). Circ. Cardiovasc. Interv. 2, 113–123 (2009).
Cheneau, E. et al. Predictors of subacute stent thrombosis: results of a systematic intravascular ultrasound study. Circulation 108, 43–47 (2003).
Fujii, K. et al. Stent underexpansion and residual reference segment stenosis are related to stent thrombosis after sirolimus-eluting stent implantation: an intravascular ultrasound study. J. Am. Coll. Cardiol. 45, 995–998 (2005).
Nakano, M. et al. Causes of early stent thrombosis in patients presenting with acute coronary syndrome: an ex vivo human autopsy study. J. Am. Coll. Cardiol. 63, 2510–2520 (2014).
Kobayashi, Y. et al. Long-term vessel response to a self-expanding coronary stent: a serial volumetric intravascular ultrasound analysis from the ASSURE Trial: A Stent vs. Stent Ultrasound Remodeling Evaluation. J. Am. Coll. Cardiol. 37, 1329–1334 (2001).
Gonzalo, N. et al. Incomplete stent apposition and delayed tissue coverage are more frequent in drug-eluting stents implanted during primary percutaneous coronary intervention for ST-segment elevation myocardial infarction than in drug-eluting stents implanted for stable/unstable angina: insights from optical coherence tomography. JACC Cardiovasc. Interv. 2, 445–452 (2009).
Tanigawa, J., Barlis, P. & Di Mario, C. Intravascular optical coherence tomography: optimisation of image acquisition and quantitative assessment of stent strut apposition. EuroIntervention 3, 128–136 (2007).
Bezerra, H. G. et al. Optical coherence tomography versus intravascular ultrasound to evaluate coronary artery disease and percutaneous coronary intervention. JACC Cardiovasc. Interv. 6, 228–236 (2013).
Ozaki, Y. et al. The fate of incomplete stent apposition with drug-eluting stents: an optical coherence tomography-based natural history study. Eur. Heart J. 31, 1470–1476 (2010).
Foin, N. et al. Incomplete stent apposition causes high shear flow disturbances and delay in neointimal coverage as a function of strut to wall detachment distance: implications for the management of incomplete stent apposition. Circ. Cardiovasc. Interv. 7, 180–189 (2014).
Tanabe, K. et al. Incomplete stent apposition after implantation of paclitaxel-eluting stents or bare metal stents: insights from the randomized TAXUS II trial. Circulation 111, 900–905 (2005).
Shah, V. M., Mintz, G. S., Apple, S. & Weissman, N. J. Background incidence of late malapposition after bare-metal stent implantation. Circulation 106, 1753–1755 (2002).
Hong, M. K. et al. Intravascular ultrasound comparison of chronic recoil among different stent designs. Am. J. Cardiol. 84, 1247–1250 (1999).
Fujino, Y., Attizzani, G. F., Nakamura, S., Costa, M. A. & Bezerra, H. G. Frequency-domain optical coherence tomography assessment of stent constriction 9 months after sirolimus-eluting stent implantation in a highly calcified plaque. JACC Cardiovasc. Interv. 6, 204–205 (2013).
Mintz, G. S., Shah, V. M. & Weissman, N. J. Regional remodeling as the cause of late stent malapposition. Circulation 107, 2660–2663 (2003).
Ako, J. et al. Late incomplete stent apposition after sirolimus-eluting stent implantation: a serial intravascular ultrasound analysis. J. Am. Coll. Cardiol. 46, 1002–1005 (2005).
Hong, M. K. et al. Late stent malapposition after drug-eluting stent implantation: an intravascular ultrasound analysis with long-term follow-up. Circulation 113, 414–419 (2006).
Hoffmann, R. et al. Impact of late incomplete stent apposition after sirolimus-eluting stent implantation on 4-year clinical events: intravascular ultrasound analysis from the multicentre, randomised, RAVEL, E-SIRIUS and SIRIUS trials. Heart 94, 322–328 (2008).
Guo, N. et al. Incidence, mechanisms, predictors, and clinical impact of acute and late stent malapposition after primary intervention in patients with acute myocardial infarction: an intravascular ultrasound substudy of the Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI) trial. Circulation 122, 1077–1084 (2010).
Hassan, A. K. et al. Late stent malapposition risk is higher after drug-eluting stent compared with bare-metal stent implantation and associates with late stent thrombosis. Eur. Heart J. 31, 1172–1180 (2010).
Hong, M. K. et al. Incidence, mechanism, predictors, and long-term prognosis of late stent malapposition after bare-metal stent implantation. Circulation 109, 881–886 (2004).
Virmani, R. et al. Localized hypersensitivity and late coronary thrombosis secondary to a sirolimus-eluting stent: should we be cautious? Circulation 109, 701–705 (2004).
Cook, S. et al. Correlation of intravascular ultrasound findings with histopathological analysis of thrombus aspirates in patients with very late drug-eluting stent thrombosis. Circulation 120, 391–399 (2009).
Guagliumi, G. et al. Examination of the in vivo mechanisms of late drug-eluting stent thrombosis: findings from optical coherence tomography and intravascular ultrasound imaging. JACC Cardiovasc. Interv. 5, 12–20 (2012).
Otsuka, F. et al. Pathology of second-generation everolimus-eluting stents versus first-generation sirolimus- and paclitaxel-eluting stents in humans. Circulation 129, 211–223 (2014).
Kim, J. S. et al. Optical coherence tomography evaluation of zotarolimus-eluting stents at 9-month follow-up: comparison with sirolimus-eluting stents. Heart 95, 1907–1912 (2009).
Kim, B. K. et al. Comparison of optical coherence tomographic assessment between first- and second-generation drug-eluting stents. Yonsei Med. J. 53, 524–529 (2012).
Kim, J. S. et al. Optical coherence tomographic comparison of neointimal coverage between sirolimus- and resolute zotarolimus-eluting stents at 9 months after stent implantation. Int. J. Cardiovasc. Imaging 28, 1281–1287 (2012).
Serruys, P. W. et al. Intravascular ultrasound findings in the multicenter, randomized, double-blind RAVEL (RAndomized study with the sirolimus-eluting VElocity balloon-expandable stent in the treatment of patients with de novo native coronary artery Lesions) trial. Circulation 106, 798–803 (2002).
Im, E. et al. Incidences, predictors, and clinical outcomes of acute and late stent malapposition detected by optical coherence tomography after drug-eluting stent implantation. Circ. Cardiovasc. Interv. 7, 88–96 (2014).
Farb, A., Burke, A. P., Kolodgie, F. D. & Virmani, R. Pathological mechanisms of fatal late coronary stent thrombosis in humans. Circulation 108, 1701–1706 (2003).
Finn, A. V. et al. Pathological correlates of late drug-eluting stent thrombosis: strut coverage as a marker of endothelialization. Circulation 115, 2435–2441 (2007).
Kotani, J. et al. Incomplete neointimal coverage of sirolimus-eluting stents: angioscopic findings. J. Am. Coll. Cardiol. 47, 2108–2111 (2006).
Takano, M. et al. Evaluation by optical coherence tomography of neointimal coverage of sirolimus-eluting stent three months after implantation. Am. J. Cardiol. 99, 1033–1038 (2007).
Takano, M. et al. Long-term follow-up evaluation after sirolimus-eluting stent implantation by optical coherence tomography: do uncovered struts persist? J. Am. Coll. Cardiol. 51, 968–969 (2008).
Takano, M. et al. Late vascular responses from 2 to 4 years after implantation of sirolimus-eluting stents: serial observations by intracoronary optical coherence tomography. Circ. Cardiovasc. Interv. 3, 476–483 (2010).
Malle, C. et al. Tissue characterization after drug-eluting stent implantation using optical coherence tomography. Arterioscler Thromb. Vasc Biol. 33, 1376–1383 (2013).
Walters, D. L. et al. Acute coronary syndrome is a common clinical presentation of in-stent restenosis. Am. J. Cardiol. 89, 491–494 (2002).
Nakazawa, G., Vorpahl, M., Finn, A. V., Narula, J. & Virmani, R. One step forward and two steps back with drug-eluting-stents: from preventing restenosis to causing late thrombosis and nouveau atherosclerosis. JACC Cardiovasc. Imaging 2, 625–628 (2009).
Nakazawa, G. et al. The pathology of neoatherosclerosis in human coronary implants bare-metal and drug-eluting stents. J. Am. Coll. Cardiol. 57, 1314–1322 (2011).
Kang, S. J. et al. Tissue characterization of in-stent neointima using intravascular ultrasound radiofrequency data analysis. Am. J. Cardiol. 106, 1561–1565 (2010).
Habara, M., Terashima, M. & Suzuki, T. Detection of atherosclerotic progression with rupture of degenerated in-stent intima five years after bare-metal stent implantation using optical coherence tomography. J. Invasive Cardiol. 21, 552–553 (2009).
Bennett, J., Coosemans, M. & Adriaenssens, T. Very late bare metal stent thrombosis due to neoatherosclerotic plaque rupture: an optical coherence tomography finding. Heart 98, 1470 (2012).
Abtahian, F. & Jang, I. K. Optical coherence tomography: basics, current application and future potential. Curr. Opin. Pharmacol. 12, 583–591 (2012).
Hou, J. et al. Development of lipid-rich plaque inside bare metal stent: possible mechanism of late stent thrombosis? An optical coherence tomography study. Heart 96, 1187–1190 (2010).
Takano, M. et al. Appearance of lipid-laden intima and neovascularization after implantation of bare-metal stents extended late-phase observation by intracoronary optical coherence tomography. J. Am. Coll. Cardiol. 55, 26–32 (2009).
Kim, J. S. et al. Quantitative and qualitative changes in DES-related neointimal tissue based on serial OCT. JACC Cardiovasc. Imaging 5, 1147–1155 (2012).
Yonetsu, T. et al. Comparison of incidence and time course of neoatherosclerosis between bare metal stents and drug-eluting stents using optical coherence tomography. Am. J. Cardiol. 110, 933–939 (2012).
Amioka, M. et al. Causes of very late stent thrombosis investigated using optical coherence tomography. Intern. Med. 53, 2031–2039 (2014).
Kang, S. J. et al. OCT analysis in patients with very late stent thrombosis. JACC Cardiovasc. Imaging 6, 695–703 (2013).
Klersy, C. et al. Use of IVUS guided coronary stenting with drug eluting stent: a systematic review and meta-analysis of randomized controlled clinical trials and high quality observational studies. Int. J. Cardiol. 170, 54–63 (2013).
Witzenbichler, B. et al. Relationship between intravascular ultrasound guidance and clinical outcomes after drug-eluting stents: the assessment of dual antiplatelet therapy with drug-eluting stents (ADAPT-DES) study. Circulation 129, 463–470 (2014).
Prati, F. et al. Angiography alone versus angiography plus optical coherence tomography to guide decision-making during percutaneous coronary intervention: the Centro per la Lotta contro l'Infarto-Optimisation of Percutaneous Coronary Intervention (CLI-OPCI) study. EuroIntervention 8, 823–829 (2012).
Chieffo, A. et al. A prospective, randomized trial of intravascular-ultrasound guided compared to angiography guided stent implantation in complex coronary lesions: the AVIO trial. Am. Heart J. 165, 65–72 (2013).
Rogacka, R., Latib, A. & Colombo, A. IVUS-guided stent implantation to improve outcome: a promise waiting to be fulfilled. Curr. Cardiol. Rev. 5, 78–86 (2009).
Yamaguchi, T. et al. Safety and feasibility of an intravascular optical coherence tomography image wire system in the clinical setting. Am. J. Cardiol. 101, 562–567 (2008).
Gonzalo, N. et al. Quantitative ex vivo and in vivo comparison of lumen dimensions measured by optical coherence tomography and intravascular ultrasound in human coronary arteries. Rev. Esp. Cardiol. 62, 615–624 (2009).
Kato, K. et al. Intracoronary imaging modalities for vulnerable plaques. J. Nippon. Med. Sch. 78, 340–351 (2011).
Nakamura, S. et al. Relationship between cholesterol crystals and culprit lesion characteristics in patients with stable coronary artery disease: an optical coherence tomography study. Clin. Res. Cardiol. 103, 1015–1021 (2014).
Sambu, N. et al. Personalised antiplatelet therapy in stent thrombosis: observations from the Clopidogrel Resistance in Stent Thrombosis (CREST) registry. Heart 98, 706–711 (2012).
Kimura, T. et al. Comparisons of baseline demographics, clinical presentation, and long-term outcome among patients with early, late, and very late stent thrombosis of sirolimus-eluting stents: observations from the Registry of Stent Thrombosis for Review and Reevaluation (RESTART). Circulation 122, 52–61 (2010).
Kubo, T. et al. Assessment of culprit lesion morphology in acute myocardial infarction: ability of optical coherence tomography compared with intravascular ultrasound and coronary angioscopy. J. Am. Coll. Cardiol. 50, 933–939 (2007).
Wong, D. T., Soh, S. Y. & Malaiapan, Y. In-stent thrombosis due to neoatherosclerosis: insight from optical coherence tomography. J. Invasive Cardiol. 25, 304 (2013).
PRESTIGE Consortium. PREvention of late Stent Thrombosis by an Interdisciplinary Global European effort: PRESTIGE. Eur. Heart J. 35, 2128–2129 (2014).
Nebeker, J. R. et al. Hypersensitivity cases associated with drug-eluting coronary stents: a review of available cases from the Research on Adverse Drug Events and Reports (RADAR) project. J. Am. Coll. Cardiol. 47, 175–181 (2006).
Stefanini, G. G. et al. Biodegradable polymer drug-eluting stents reduce the risk of stent thrombosis at 4 years in patients undergoing percutaneous coronary intervention: a pooled analysis of individual patient data from the ISAR-TEST 3, ISAR-TEST 4, and LEADERS randomized trials. Eur. Heart J. 33, 1214–1222 (2012).
Barlis, P. et al. An optical coherence tomography study of a biodegradable vs. durable polymer-coated limus-eluting stent: a LEADERS trial sub-study. Eur. Heart J. 31, 165–176 (2010).
Navarese, E. P. et al. Safety and efficacy outcomes of first and second generation durable polymer drug eluting stents and biodegradable polymer biolimus eluting stents in clinical practice: comprehensive network meta-analysis. BMJ 347, f6530 (2013).
Palmerini, T. et al. Clinical outcomes with bioabsorbable polymer- versus durable polymer-based drug-eluting and bare-metal stents: evidence from a comprehensive network meta-analysis. J. Am. Coll. Cardiol. 63, 299–307 (2014).
Bangalore, S. et al. Bare metal stents, durable polymer drug eluting stents, and biodegradable polymer drug eluting stents for coronary artery disease: mixed treatment comparison meta-analysis. BMJ 347, f6625 (2013).
Garcia-Garcia, H. M. et al. Assessing bioresorbable coronary devices: methods and parameters. JACC Cardiovasc. Imaging 7, 1130–1148 (2014).
Wiebe, J., Nef, H. M. & Hamm, C. W. Current status of bioresorbable scaffolds in the treatment of coronary artery disease. J. Am. Coll. Cardiol. 64, 2541–2551 (2014).
Serruys, P. W. et al. A bioabsorbable everolimus-eluting coronary stent system (ABSORB): 2-year outcomes and results from multiple imaging methods. Lancet 373, 897–910 (2009).
García-García, H. M. et al. Assessment of the absorption process following bioabsorbable everolimus-eluting stent implantation: temporal changes in strain values and tissue composition using intravascular ultrasound radiofrequency data analysis: a substudy of the ABSORB clinical trial. EuroIntervention 4, 443–448 (2009).
Gomez-Lara, J. et al. A comparative assessment by optical coherence tomography of the performance of the first and second generation of the everolimus-eluting bioresorbable vascular scaffolds. Eur. Heart J. 32, 294–304 (2011).
Serruys, P. W. et al. Dynamics of vessel wall changes following the implantation of the absorb everolimus-eluting bioresorbable vascular scaffold: a multi-imaging modality study at 6, 12, 24 and 36 months. EuroIntervention 9, 1271–1284 (2014).
Ormiston, J. A. et al. A bioabsorbable everolimus-eluting coronary stent system for patients with single de-novo coronary artery lesions (ABSORB): a prospective open-label trial. Lancet 371, 899–907 (2008).
Simsek, C. et al. Long-term invasive follow-up of the everolimus-eluting bioresorbable vascular scaffold: five-year results of multiple invasive imaging modalities. EuroIntervention http://dx.doi.org/10.4244/EIJY14M10_12.
Karanasos, A. et al. OCT Assessment of the long-term vascular healing response 5 years after everolimus-eluting bioresorbable vascular scaffold. J. Am. Coll. Cardiol. 64, 2343–2356 (2014).
Serruys, P. W. et al. Evaluation of the second generation of a bioresorbable everolimus drug-eluting vascular scaffold for treatment of de novo coronary artery stenosis: six-month clinical and imaging outcomes. Circulation 122, 2301–2312 (2010).
Allahwala, U. K., et al. Clinical utility of optical coherence tomography (OCT) in the optimisation of Absorb bioresorbable vascular scaffold deployment during percutaneous coronary intervention. EuroIntervention 10, 1154–1159 (2015).
Gomez-Lara, J. et al. Serial analysis of the malapposed and uncovered struts of the new generation of everolimus-eluting bioresorbable scaffold with optical coherence tomography. JACC Cardiovasc. Interv. 4, 992–1001 (2011).
Serruys, P. W. et al. Evaluation of the second generation of a bioresorbable everolimus-eluting vascular scaffold for the treatment of de novo coronary artery stenosis: 12-month clinical and imaging outcomes. J. Am. Coll. Cardiol. 58, 1578–1588 (2011).
Ormiston, J. A. et al. First serial assessment at 6 months and 2 years of the second generation of absorb everolimus-eluting bioresorbable vascular scaffold: a multi-imaging modality study. Circ. Cardiovasc. Interv. 5, 620–632 (2012).
Bourantas, C. V. et al. Bioresorbable vascular scaffold treatment induces the formation of neointimal cap that seals the underlying plaque without compromising the luminal dimensions: a concept based on serial optical coherence tomography data. EuroIntervention http://dx.doi.org/10.4244/EIJY14M10_06.
Onuma, Y. et al. Incidence and imaging outcomes of acute scaffold disruption and late structural discontinuity after implantation of the absorb everolimus-eluting fully bioresorbable vascular scaffold: optical coherence tomography assessment in the ABSORB Cohort B trial (a clinical evaluation of the bioabsorbable everolimus eluting coronary stent system in the treatment of patients with de novo native coronary artery lesions). JACC Cardiovasc. Interv. 7, 1400–1411 (2014).
Verheye, S. et al. A next-generation bioresorbable coronary scaffold system: from bench to first clinical evaluation: 6- and 12-month clinical and multimodality imaging results. JACC Cardiovasc. Interv. 7, 89–99 (2014).
Capodanno, D. et al. Percutaneous coronary intervention with everolimus-eluting bioresorbable vascular scaffolds in routine clinical practice: early and midterm outcomes from the European multicentre GHOST-EU registry. EuroIntervention 10, 1144–1153 (2015).
van Werkum, J. W. et al. Predictors of coronary stent thrombosis: the Dutch Stent Thrombosis Registry. J. Am. Coll. Cardiol. 53, 1399–1409 (2009).
Waksman, R. et al. Correlates and outcomes of late and very late drug-eluting stent thrombosis: results from DESERT (International Drug-Eluting Stent Event Registry of Thrombosis). JACC Cardiovasc. Interv. 7, 1093–1102 (2014).
Moussa, I. et al. Subacute stent thrombosis in the era of intravascular ultrasound-guided coronary stenting without anticoagulation: frequency, predictors and clinical outcome. J. Am. Coll. Cardiol. 29, 6–12 (1997).
Park, D. W. et al. Frequency of and risk factors for stent thrombosis after drug-eluting stent implantation during long-term follow-up. Am. J. Cardiol. 98, 352–356 (2006).
Rabinovitz, A. et al. Association between off-label use of drug-eluting stents and subsequent stent thrombosis: a case-control analysis. J. Invasive Cardiol. 22, 15–19 (2010).
Wiviott, S. D. et al. Prasugrel versus clopidogrel in patients with acute coronary syndromes. N. Engl. J. Med. 357, 2001–2015 (2007).
Steg, P. G. et al. Stent thrombosis with ticagrelor versus clopidogrel in patients with acute coronary syndromes: an analysis from the prospective, randomized PLATO trial. Circulation 128, 1055–1065 (2013).
Matetzky, S. et al. Clopidogrel resistance is associated with increased risk of recurrent atherothrombotic events in patients with acute myocardial infarction. Circulation 109, 3171–3175 (2004).
Wenaweser, P. & Hess, O. Stent thrombosis is associated with an impaired response to antiplatelet therapy. J. Am. Coll. Cardiol. 46, CS5–CS6 (2005).
Ferrari, E., Benhamou, M., Cerboni, P. & Marcel, B. Coronary syndromes following aspirin withdrawal: a special risk for late stent thrombosis. J. Am. Coll. Cardiol. 45, 456–459 (2005).
Attizzani, G. F., Capodanno, D., Ohno, Y. & Tamburino, C. Mechanisms, pathophysiology, and clinical aspects of incomplete stent apposition. J. Am. Coll. Cardiol. 63, 1355–1367 (2014).
Kim, S. et al. Comparison of early strut coverage between zotarolimus- and everolimus-eluting stents using optical coherence tomography. Am. J. Cardiol. 111, 1–5 (2013).
Kim, J. S. et al. ComparisOn of neointimal coVerage betwEen zotaRolimus-eluting stent and everolimus-eluting stent using Optical Coherence Tomography (COVER OCT). Am. Heart J. 163, 601–607 (2012).
Kim, J. S. et al. Comparison of neointimal coverage of sirolimus-eluting stents and paclitaxel-eluting stents using optical coherence tomography at 9 months after implantation. Circ. J. 74, 320–326 (2010).
Kim, T. H. et al. Long-term (≥2 years) follow-up optical coherence tomographic study after sirolimus- and paclitaxel-eluting stent implantation: comparison to 9-month follow-up results. Int. J. Cardiovasc. Imaging 27, 875–881 (2011).
Adriaenssens, T. et al. Optical coherence tomography study of healing characteristics of paclitaxel-eluting balloons vs. everolimus-eluting stents for in-stent restenosis: the SEDUCE (Safety and Efficacy of a Drug elUting balloon in Coronary artery rEstenosis) randomised clinical trial. EuroIntervention 10, 439–448 (2014).
Kim, S. J. et al. Comparison of zotarolimus-eluting stent and everolimus-eluting stent for vascular healing response: serial 3-month and 12-month optical coherence tomography study. Coron. Artery Dis. 24, 431–439 (2013).
Li, S. et al. Evaluation of neointimal coverage and apposition with various drug-eluting stents over 12 months after implantation by optical coherence tomography. Int. J. Cardiol. 162, 166–171 (2013).
Räber, L. et al. Long-term vascular healing in response to sirolimus- and paclitaxel-eluting stents: an optical coherence tomography study. JACC Cardiovasc. Interv. 5, 946–957 (2012).
Acknowledgements
I.-K.J. is also affiliated with the Division of Cardiology, Kyung Hee University, Seoul, South Korea.
Author information
Authors and Affiliations
Contributions
Both authors researched data for the article, discussed its content, wrote the article, and reviewed and edited the manuscript before submission.
Corresponding author
Ethics declarations
Competing interests
I.-K.J. declares that he has received a research grant and honorarium from St. Jude Medical and research grants from Boston Scientific and Medtronic. D.S.O. declares no competing interests.
Rights and permissions
About this article
Cite this article
Ong, D., Jang, IK. Causes, assessment, and treatment of stent thrombosis—intravascular imaging insights. Nat Rev Cardiol 12, 325–336 (2015). https://doi.org/10.1038/nrcardio.2015.32
Published:
Issue Date:
DOI: https://doi.org/10.1038/nrcardio.2015.32
This article is cited by
-
Intracoronary Imaging Assessment of Stent Thrombosis
Current Cardiovascular Imaging Reports (2023)
-
Mean platelet volume/platelet count ratio as a predictor of stent thrombosis in patients with ST-segment–elevation myocardial infarction
Irish Journal of Medical Science (1971 -) (2021)
-
Clinical outcomes after percutaneous coronary intervention for early versus late and very late stent thrombosis: a systematic review and meta-analysis
Journal of Thrombosis and Thrombolysis (2021)
-
Comparison of the vessel healing process after everolimus-eluting stent and bare metal stent implantations in patients with ST-elevation myocardial infarction
Heart and Vessels (2019)
-
Dual-therapy stent shows promise
Nature Reviews Cardiology (2018)