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2017 ; 56
(3
): 259-268
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Heterogeneous Intravascular Ultrasound Findings of Stent Thrombosis
#MMPMID28154268
Morofuji T
; Inaba S
; Aisu H
; Takahashi K
; Saito M
; Higashi H
; Yoshii T
; Sumimoto T
Intern Med
2017[]; 56
(3
): 259-268
PMID28154268
show ga
Objective The underlying mechanisms of stent thrombosis are not completely
understood. Methods We experienced 12 definite stent thrombosis cases (1 early, 1
late, and 10 very late) at our hospital from July 2011 to April 2016 and
evaluated the possible causes of stent thrombosis by intravascular ultrasound
(IVUS). Results Five different potential morphological causes of stent thrombosis
(neoatherosclerosis, stent malapposition, stent fracture, edge dissection, and
stent underexpansion) were detected by IVUS in 10 cases (83.3%); in 1 of the
remaining 2 cases, the discontinuation of antithrombotic drugs resulted in early
stent thrombosis without abnormal IVUS findings. Of the 12 stent thrombosis
cases, 4 occurred at a bare-metal stent (average time from stent implantation,
106 months); in all 12, significant neointimal hyperplasia was observed on IVUS,
and 2 had plaque ruptures at an in-stent or proximal reference. Malapposed stent
struts were observed in three very-late stent thromboses, and all of these
underwent sirolimus-eluting stent implantation. Stent thrombosis due to
mechanical (stent fracture) or procedure-related complications (edge dissection
and stent underexpansion) was observed in three cases. Conclusion In patients
with stent thrombosis, heterogeneous findings were observed in IVUS. This IVUS
case series illustrates the possible mechanisms of stent thrombosis.