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Calcified plaque rupture and very late stent thrombosis after bare-metal stent implantation

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Abstract

Very late stent thrombosis (>1 year: VLST) is a major concern in the drug-eluting stent (DES) era. VLST occurs not only in patients implanted with DESs but also in those implanted with bare-metal stents (BMSs). We examined intravascular ultrasound (IVUS) findings in patients with VLST after BMS implantation. Five consecutive patients presented with VLST as ST elevation myocardial infarction. VLST occurred at a mean of 9.5 years after BMS implantation. In the IVUS findings, the minimum stent area was 7.8 ± 1.2 mm2. None of the patients had incomplete stent apposition or stent underexpansion, which was defined as a stent expansion index of <0.8. The mean stent expansion index was 1.01. Calcium deposits in the previous stented segment were observed in 4 patients (80%), and a total of 14 calcium deposits were observed in all patients. The calcification pattern was superficial (78.5%) and spotty (57.1%) within a calcium arc of <90°. The mean calcium arc was 72.5° ± 88.5°. A ruptured plaque with an intraluminal flap was detected in all cases. According to the IVUS findings of ruptured plaque and calcium deposits, VLST after BMS might be caused by a thrombus formation subsequent to a calcified atherosclerotic plaque rupture.

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Authors and Affiliations

  1. Department of Cardiology, Yokohama Rosai Hospital, 3211 Kozukue-cho, Kohoku-ku, Yokohama, Kanagawa, Japan

    Kazuhiko Yumoto, Tagayasu Anzai, Hajime Aoki, Akira Inoue, Shuhei Funada, Hiroki Nishiyama, Shingo Tanaka, Shinya Kowase, Yasuhiro Shirai, Kenji Kurosaki, Akihiko Nogami & Kenichi Kato

  2. Department of Cardiovascular Medicine, Juntendo University School of Medicine, Tokyo, Japan

    Hiroyuki Daida

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  1. Kazuhiko Yumoto
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  2. Tagayasu Anzai
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  3. Hajime Aoki
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  5. Shuhei Funada
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  12. Hiroyuki Daida
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  13. Kenichi Kato
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Correspondence to Kazuhiko Yumoto.

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Yumoto, K., Anzai, T., Aoki, H. et al. Calcified plaque rupture and very late stent thrombosis after bare-metal stent implantation. Cardiovasc Interv and Ther 26, 252–259 (2011). https://doi.org/10.1007/s12928-011-0070-3

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  • DOI: https://doi.org/10.1007/s12928-011-0070-3

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