Cardiovascular Intervention and Therapeutics

, Volume 26, Issue 3, pp 263–268

Very late stent thrombosis and neointimal plaque rupture after implantation of sirolimus-eluting stents: observations with angiography, IVUS and OCT

  • Nobuo Sakamoto
  • Kazuhiko Nakazato
  • Tomofumi Misaka
  • Hiroyuki Mizukami
  • Hiroyuki Kunii
  • Hitoshi Suzuki
  • Shu-ichi Saitoh
  • Yasuchika Takeishi
Case Report

Abstract

Drug-eluting stent (DES) dramatically reduces the incidence of restenosis and rates of target lesion revascularization. Although several reports suggest that very late stent thrombosis could occur in patients after DES implantation, neointimal plaque rupture may be uncommon in the patients treated with DES compared with bare-metal stent. It is unclear that the reason why the patient in acute coronary syndrome (ACS) treated with DES has a high frequency of very late stent thrombosis and pathophysiological mechanisms of neointimal plaque rupture after DES implantation. We report a case of very late stent thrombosis with the findings of neontimal plaque rupture as well as incomplete stent apposition 4 years after sirolimus-eluting stent implantation in ACS.

Keywords

Sirolimus-eluting stent (SES) Intravascular ultrasound (IVUS) Very late stent thrombosis Incomplete stent apposition (ISA) Neointimal plaque rupture 

References

  1. 1.
    Weisz G, Leon MB, Holmes DR Jr, Kereiakes DJ, Popma JJ, Teirstein PS, et al. Five-year follow-up after sirolimus-eluting stent implantation results of the SIRIUS (sirolimus-eluting stent in de novo native coronary lesions) trial. J Am Coll Cardiol. 2009;53:1488–97.PubMedCrossRefGoogle Scholar
  2. 2.
    Stettler C, Wandel S, Allemann S, Kastrati A, Morice MC, Schoemig A, et al. Outcomes associated with drug-eluting and bare-metal stents: a collaborative network meta-analysis. Lancet. 2007;370:937–48.PubMedCrossRefGoogle Scholar
  3. 3.
    Stone GW, Ellis SG, Colombo A, Dawkins KD, Grube E, Cutlip DE, et al. Offsetting impact of thrombosis and restenosis on the occurrence of death and myocardial infarction after paclitaxel-eluting and BMS implantation. Circulation. 2007;115:2842–7.PubMedCrossRefGoogle Scholar
  4. 4.
    Kastrati A, Mehilli J, Pache J, Kaiser C, Valgimigli M, Kelbaek H, et al. Analysis of 14 trials comparing sirolimus-eluting stents with bare-metal stents. N Engl J Med. 2007;356:1030–9.PubMedCrossRefGoogle Scholar
  5. 5.
    Lee CW, Kang SJ, Park DW, Lee SH, Kim YH, Kim JJ, et al. Intravascular ultrasound findings in patients with very late thrombosis after either drug-eluting or bare-metal stent implantation. J Am Coll Cardiol. 2010;55:1936–42.PubMedCrossRefGoogle Scholar
  6. 6.
    Cook S, Ladich E, Nakazawa G, Eshtehardi P, Neidhart M, Vogel R, et al. Correlation of intravascular ultrasound findings with histopathological analysis of thrombus aspirates in patients with very late drug-eluting stent thrombosis. Circulation. 2009;120:391–9.PubMedCrossRefGoogle Scholar
  7. 7.
    Hong MK, Mintz GS, Lee CW, Kim YH, Lee SW, Song JM, et al. Incidence, mechanism, predictors, and long-term prognosis of late stent malapposition after bare-metal stent implantation. Circulation. 2004;109:881–6.PubMedCrossRefGoogle Scholar
  8. 8.
    Daeman J, Tanimoto S, Garcia-Garcia HM, Kukreja N, van de Sande M, Sianos G, et al. Comparison of three-year clinical outcome of sirolimus- and paclitaxel-eluting stents versus bare metal stents in patients with ST-segment elevation myocardial infarction (from the RESEARCH and T-SEARCH Registries). Am J Cardiol. 2007;99:1027–32.CrossRefGoogle Scholar
  9. 9.
    Fajadet J, Morice MC, Bode C, Barragan P, Serruys PW, Wijns W, et al. Maintenance of long-term clinical benefit with sirolimus-eluting coronary stents: three-year results of the RAVEL trial. Circulation. 2005;111:1040–4.PubMedCrossRefGoogle Scholar
  10. 10.
    Moses JW, Leon MB, Popma JJ, Fitzgerald PJ, Holmes DR, O’Shaughnessy C, et al. Sirolimus-eluting stents versus standard stents in patients with stenosis in a native coronary artery. N Engl J Med. 2003;349:1315–23.PubMedCrossRefGoogle Scholar
  11. 11.
    Weisz G, Leon MB, Holmes DR Jr, Kereiakes DJ, Clark MR, Cohen BM, et al. Two-year outcomes after sirolimus-eluting stent implantation: results from the sirolimus-eluting stent in de novo native coronary lesions (SIRIUS) trial. J Am Coll Cardiol. 2006;47:1350–5.PubMedCrossRefGoogle Scholar
  12. 12.
    Oikawa Y, Yajima J, Costa MA, Matsuno S, Akabane M, Funada R, et al. Intravascular ultrasound, angioscopic and histopathological characterisation of heterogeneous patterns of restenosis after sirolimus-eluting stent implantation: insights into potential “thromborestenosis” phenomenon. Eurointervention. 2010;6:380–7.PubMedCrossRefGoogle Scholar
  13. 13.
    Kuchulakanti PK, Chu WW, Torguson R, Ohlmann P, Rha SW, Clavijo LC, et al. Correlates and long-term outcomes of angiographically proven stent thrombosis with sirolimus- and paclitaxel-eluting stents. Circulation. 2006;113:1108–13.PubMedCrossRefGoogle Scholar
  14. 14.
    Camenzind E, Steg PG, Wijns W. Stent thrombosis late after implantation of first-generation drug-eluting stents: a cause for concern. Circulation. 2007;115:1440–55 (discussion 1455).Google Scholar
  15. 15.
    Nordmann AJ, Briel M, Bucher HC. Mortality in randomized controlled trials comparing drug-eluting vs. bare metal stents in coronary artery disease: a meta-analysis. Eur Heart J. 2006;27:2784–814.PubMedCrossRefGoogle Scholar
  16. 16.
    Lagerqvist B, James SK, Stenestrand U, Lindback J, Nilsson T, Wallentin L. Long-term outcomes with drug-eluting stents versus bare-metal stents in Sweden. N Engl J Med. 2007;356:1009–19.PubMedCrossRefGoogle Scholar
  17. 17.
    Cutlip DE, Windecker S, Mehran R, Boam A, Cohen DJ, van Es GA, et al. Clinical end points in coronary stent trials: a case for standardized definitions. Circulation. 2007;115:2344–51.PubMedCrossRefGoogle Scholar
  18. 18.
    Iakovou I, Schmidt T, Bonizzoni E, Ge L, Sangiorgi GM, Stankovic G, et al. Incidence, predictors, and outcome of thrombosis after successful implantation of drug-eluting stents. JAMA. 2005;293:2126–30.PubMedCrossRefGoogle Scholar
  19. 19.
    Windecker S, Remondino A, Eberli FR, Juni P, Raber L, Wenaweser P, et al. Sirolimuseluting and paclitaxel-eluting stents for coronary revascularization. N Engl J Med. 2005;353:653–62.PubMedCrossRefGoogle Scholar
  20. 20.
    Mintz GS, Shah VM, Weissman NJ. Regional remodeling as the cause of late stent malapposition. Circulation. 2003;107:2660–3.PubMedCrossRefGoogle Scholar
  21. 21.
    Mintz GS, Weissman NJ, Fitzgerald PJ. Intravascular ultrasound assessment of the mechanisms and results of brachytherapy. Circulation. 2001;104:1320–5.PubMedCrossRefGoogle Scholar
  22. 22.
    Serruys PW, Degertekin M, Tanabe K, 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. 2002;106:798–803.PubMedCrossRefGoogle Scholar
  23. 23.
    Hong MK, Mintz GS, Lee CW, Park DW, Park KM, Le BK, et al. Late stent malapposition after drug-eluting stent implantation: an intravascular ultrasound analysis with long-term follow-up. Circulation. 2006;113:414–9.PubMedCrossRefGoogle Scholar
  24. 24.
    Zhang RY DUR, Zhu ZB, Zhang Q, Hu J, Lu AK, et al. Acute coronary syndrome is an independent risk factor for late incomplete stent apposition after sirolimus-eluting stent implantation. Chin Med J. 2008;121:2504–8.PubMedGoogle Scholar
  25. 25.
    Higo T, Ueda Y, Oyabu J, Okada K, Nishio M, Hirata A, et al. Atherosclerotic and thrombogenic neointima formed over sirolimus drug-eluting stent: an angioscopic study. JACC Cardiovasc Imaging. 2009;2:616–24.PubMedCrossRefGoogle Scholar
  26. 26.
    Nakazawa G, Vorpahl M, Finn AV, Narula J, Virmani R. One step forward and two steps back with drug-eluting stents. J Am Coll Cardiol Img. 2009;2:623–8.Google Scholar
  27. 27.
    Kubo T, Imanishi T, Kitabata H, Kuroi A, Ueno S, Yamano T, et al. Comparison of vascular response after sirolimus-eluting stent implantation between patients with unstable and stable angina pectoris: a serial optical coherence tomography study. JACC Cardiovasc Imaging. 2008;1:475–84.PubMedCrossRefGoogle Scholar
  28. 28.
    Mauri L, Silbaugh TS, Garg P, Wolf RE, Zelevinsky K, Lovett A, et al. Drug-eluting or bare-metal stents for acute myocardial infarction. N Engl J Med. 2008;359:1330–42.PubMedCrossRefGoogle Scholar
  29. 29.
    Laarman GJ, Suttorp MJ, Dirksen MT, van Heerebeek L, Kiemeneij F, Slagboom T, et al. Paclitaxel-eluting versus uncoated stents in primary percutaneous coronary intervention. N Engl J Med. 2006;355:1105–13.PubMedCrossRefGoogle Scholar
  30. 30.
    Valgimigli M, Percoco G, Malagutti P, Campo G, Ferrari F, Barbieri D, et al. Tirofiban and sirolimus-eluting stent vs abciximab and bare-metal stent for acute myocardial infarction: a randomized trial. JAMA. 2005;293:2109–17.PubMedCrossRefGoogle Scholar
  31. 31.
    Cooks S, Wenaweser P, Togni M, Billinger M, Morger C, Seiler C, et al. Incomplete stent apposition and very late stent thrombosis after drug-eluting stent implantation. Circulation. 2007;115:2426–34.CrossRefGoogle Scholar
  32. 32.
    Park DW, Park SW, Park KH, Lee BK, Kim YH, Lee CW, et al. Frequency of and risk factors for stent thrombosis after drug-eluting stent implantation during long-term follow-up. Am J Cardiol. 2006;98:352–6.PubMedCrossRefGoogle Scholar

Copyright information

© Japanese Association of Cardiovascular Intervention and Therapeutics 2011

Authors and Affiliations

  • Nobuo Sakamoto
    • 1
  • Kazuhiko Nakazato
    • 1
  • Tomofumi Misaka
    • 1
  • Hiroyuki Mizukami
    • 1
  • Hiroyuki Kunii
    • 1
  • Hitoshi Suzuki
    • 1
  • Shu-ichi Saitoh
    • 1
  • Yasuchika Takeishi
    • 1
  1. 1.Department of Cardiology and HematologyFukushima Medical UniversityFukushimaJapan

Personalised recommendations