Angiographically confirmed stent thrombosis in contemporary practice: Insights from intravascular ultrasound

Ehrin J. Armstrong, Andrew T. Kwa, Khung Keong Yeo, Ehtisham Mahmud, Usman Javed, Mitul Patel, Kendrick A. Shunk, John S. MacGregor, Reginald Low, Jason H Rogers

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Objective: We hypothesized that patients presenting with stent thrombosis (ST) have a high prevalence of stent underexpansion and malapposition when assessed by intravascular ultrasound (IVUS). Background: IVUS can provide mechanistic insight into mechanical factors including stent underexpansion malapposition and fracture that may predispose to ST. Methods: All consecutive cases of angiographically confirmed ST from a multicenter registry (from 2005 to 2010) were reviewed. All IVUS images were reviewed off-line for the presence of stent underexpansion malapposition, and fracture. Kaplan-Meier analysis was used to determine whether use of IVUS at the time of ST was associated with long-term mortality and major adverse cardiovascular events. Results: IVUS was performed in 32 of 173 subjects with ST (18%). Stent underexpansion was present in 82% of cases and in all cases of early ST, with a mean stent expansion of 0.7 ± 0.23 by MUSIC criteria. Stent malapposition was most frequently observed in very late ST (40%). In-hospital mortality was similar between subjects who had IVUS performed at the time of ST when compared with the non-IVUS group (3.2% vs. 4.3%, P = 0.8). Subjects who had IVUS performed at the time of ST had lower rates of mortality (HR 0.4, 95% CI 0.1-1.6, P =0.2) and major adverse cardiovascular events (HR 0.5, 95% CI 0.2-1.4, P =0.2) at follow-up, but these values were not statistically significant. Conclusions: There is a high prevalence of stent underexpansion in early ST, while the prevalence of malapposition is higher in very late ST. Use of IVUS during treatment for ST may identify mechanisms underlying the development of ST.

Original languageEnglish (US)
Pages (from-to)782-790
Number of pages9
JournalCatheterization and Cardiovascular Interventions
Volume81
Issue number5
DOIs
StatePublished - 2013

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Stents
Thrombosis
Mortality
Kaplan-Meier Estimate
Hospital Mortality

Keywords

  • Acute coronary syndrome (ACS) intravascular ultrasound (IVUS) thrombosis (THRM)
  • Intravascular ultrasound
  • Stent thrombosis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging
  • Medicine(all)

Cite this

Angiographically confirmed stent thrombosis in contemporary practice : Insights from intravascular ultrasound. / Armstrong, Ehrin J.; Kwa, Andrew T.; Yeo, Khung Keong; Mahmud, Ehtisham; Javed, Usman; Patel, Mitul; Shunk, Kendrick A.; MacGregor, John S.; Low, Reginald; Rogers, Jason H.

In: Catheterization and Cardiovascular Interventions, Vol. 81, No. 5, 2013, p. 782-790.

Research output: Contribution to journalArticle

Armstrong, Ehrin J. ; Kwa, Andrew T. ; Yeo, Khung Keong ; Mahmud, Ehtisham ; Javed, Usman ; Patel, Mitul ; Shunk, Kendrick A. ; MacGregor, John S. ; Low, Reginald ; Rogers, Jason H. / Angiographically confirmed stent thrombosis in contemporary practice : Insights from intravascular ultrasound. In: Catheterization and Cardiovascular Interventions. 2013 ; Vol. 81, No. 5. pp. 782-790.
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title = "Angiographically confirmed stent thrombosis in contemporary practice: Insights from intravascular ultrasound",
abstract = "Objective: We hypothesized that patients presenting with stent thrombosis (ST) have a high prevalence of stent underexpansion and malapposition when assessed by intravascular ultrasound (IVUS). Background: IVUS can provide mechanistic insight into mechanical factors including stent underexpansion malapposition and fracture that may predispose to ST. Methods: All consecutive cases of angiographically confirmed ST from a multicenter registry (from 2005 to 2010) were reviewed. All IVUS images were reviewed off-line for the presence of stent underexpansion malapposition, and fracture. Kaplan-Meier analysis was used to determine whether use of IVUS at the time of ST was associated with long-term mortality and major adverse cardiovascular events. Results: IVUS was performed in 32 of 173 subjects with ST (18{\%}). Stent underexpansion was present in 82{\%} of cases and in all cases of early ST, with a mean stent expansion of 0.7 ± 0.23 by MUSIC criteria. Stent malapposition was most frequently observed in very late ST (40{\%}). In-hospital mortality was similar between subjects who had IVUS performed at the time of ST when compared with the non-IVUS group (3.2{\%} vs. 4.3{\%}, P = 0.8). Subjects who had IVUS performed at the time of ST had lower rates of mortality (HR 0.4, 95{\%} CI 0.1-1.6, P =0.2) and major adverse cardiovascular events (HR 0.5, 95{\%} CI 0.2-1.4, P =0.2) at follow-up, but these values were not statistically significant. Conclusions: There is a high prevalence of stent underexpansion in early ST, while the prevalence of malapposition is higher in very late ST. Use of IVUS during treatment for ST may identify mechanisms underlying the development of ST.",
keywords = "Acute coronary syndrome (ACS) intravascular ultrasound (IVUS) thrombosis (THRM), Intravascular ultrasound, Stent thrombosis",
author = "Armstrong, {Ehrin J.} and Kwa, {Andrew T.} and Yeo, {Khung Keong} and Ehtisham Mahmud and Usman Javed and Mitul Patel and Shunk, {Kendrick A.} and MacGregor, {John S.} and Reginald Low and Rogers, {Jason H}",
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T1 - Angiographically confirmed stent thrombosis in contemporary practice

T2 - Insights from intravascular ultrasound

AU - Armstrong, Ehrin J.

AU - Kwa, Andrew T.

AU - Yeo, Khung Keong

AU - Mahmud, Ehtisham

AU - Javed, Usman

AU - Patel, Mitul

AU - Shunk, Kendrick A.

AU - MacGregor, John S.

AU - Low, Reginald

AU - Rogers, Jason H

PY - 2013

Y1 - 2013

N2 - Objective: We hypothesized that patients presenting with stent thrombosis (ST) have a high prevalence of stent underexpansion and malapposition when assessed by intravascular ultrasound (IVUS). Background: IVUS can provide mechanistic insight into mechanical factors including stent underexpansion malapposition and fracture that may predispose to ST. Methods: All consecutive cases of angiographically confirmed ST from a multicenter registry (from 2005 to 2010) were reviewed. All IVUS images were reviewed off-line for the presence of stent underexpansion malapposition, and fracture. Kaplan-Meier analysis was used to determine whether use of IVUS at the time of ST was associated with long-term mortality and major adverse cardiovascular events. Results: IVUS was performed in 32 of 173 subjects with ST (18%). Stent underexpansion was present in 82% of cases and in all cases of early ST, with a mean stent expansion of 0.7 ± 0.23 by MUSIC criteria. Stent malapposition was most frequently observed in very late ST (40%). In-hospital mortality was similar between subjects who had IVUS performed at the time of ST when compared with the non-IVUS group (3.2% vs. 4.3%, P = 0.8). Subjects who had IVUS performed at the time of ST had lower rates of mortality (HR 0.4, 95% CI 0.1-1.6, P =0.2) and major adverse cardiovascular events (HR 0.5, 95% CI 0.2-1.4, P =0.2) at follow-up, but these values were not statistically significant. Conclusions: There is a high prevalence of stent underexpansion in early ST, while the prevalence of malapposition is higher in very late ST. Use of IVUS during treatment for ST may identify mechanisms underlying the development of ST.

AB - Objective: We hypothesized that patients presenting with stent thrombosis (ST) have a high prevalence of stent underexpansion and malapposition when assessed by intravascular ultrasound (IVUS). Background: IVUS can provide mechanistic insight into mechanical factors including stent underexpansion malapposition and fracture that may predispose to ST. Methods: All consecutive cases of angiographically confirmed ST from a multicenter registry (from 2005 to 2010) were reviewed. All IVUS images were reviewed off-line for the presence of stent underexpansion malapposition, and fracture. Kaplan-Meier analysis was used to determine whether use of IVUS at the time of ST was associated with long-term mortality and major adverse cardiovascular events. Results: IVUS was performed in 32 of 173 subjects with ST (18%). Stent underexpansion was present in 82% of cases and in all cases of early ST, with a mean stent expansion of 0.7 ± 0.23 by MUSIC criteria. Stent malapposition was most frequently observed in very late ST (40%). In-hospital mortality was similar between subjects who had IVUS performed at the time of ST when compared with the non-IVUS group (3.2% vs. 4.3%, P = 0.8). Subjects who had IVUS performed at the time of ST had lower rates of mortality (HR 0.4, 95% CI 0.1-1.6, P =0.2) and major adverse cardiovascular events (HR 0.5, 95% CI 0.2-1.4, P =0.2) at follow-up, but these values were not statistically significant. Conclusions: There is a high prevalence of stent underexpansion in early ST, while the prevalence of malapposition is higher in very late ST. Use of IVUS during treatment for ST may identify mechanisms underlying the development of ST.

KW - Acute coronary syndrome (ACS) intravascular ultrasound (IVUS) thrombosis (THRM)

KW - Intravascular ultrasound

KW - Stent thrombosis

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