Late Angiographic Stent Thrombosis (LAST) Events With Drug-Eluting Stents (original) (raw)
Catheterization and Cardiovascular Interventions, 2007
Objectives: To evaluate stent thrombosis (ST) rate after sirolimus-eluting stent (SES) and paclitaxel-eluting stent (PES) implantation in daily clinical practice. Background: The safety profile of drug-eluting stents (DES) was predominantly determined in randomized clinical trials with narrow inclusion criteria. Concerns about ST have been raised in unselected patients treated with DES. Methods: We prospectively evaluated 867 patients undergoing DES implantation, 618 patients with SES, and 249 with PES, in a single academic center. Results: Multivessel disease was present in 72% of patients, multivessel stenting was performed in 17%, long (>18 mm) lesions were treated in 30%, and multiple stents per lesion were needed in 31%. On average, 1.7 6 0.8 stents per patient were implanted (stented segment length: 32 6 25 mm/vessel). IIb/ IIIa inhibitors were used in 7.5%. Intravascular ultrasound (IVUS) guidance was employed in 65% of SES and 50% of PES implantations, and the procedural success rate was 100% in SES and 99% in PES cases. Six-month follow-up was performed in all patients, whereas one-year follow-up was completed in 87% patients of the SES group and in 95% of the PES group. We considered that ST occurred when angiographic evidence of thrombus was available, or when patients experienced sudden cardiac death or either ST-elevation or non-ST-elevation myocardial infarction (MI) through the 12-month follow-up period. The overall incidence of ST was 0.9% (0.4% in SES and 2% in PES, P = 0.03). Of the eight ST, two (25%) were acute, four (50%) subacute, one (12.5%) was a late event, and one (12.5%) a very late event. Seven ST were confirmed by angiography. No IVUS guidance was used in 4/8 (50%) ST patients, while antiplatelet therapy was prematurely discontinued in 3/8 (37.5%). Among ST patients, mortality and nonfatal MI rates were 25% and 37.5%, respectively. No ST was diagnosed between 6 and 12 months, while one very late thrombosis occurred at 15 months. Conclusions: The incidence of ST after DES use in daily clinical practice is low and similar to that observed in randomized clinical trials.
American Journal of Cardiology, 2006
Despite concerns regarding the long-term safety of drug-eluting stent (DES) implantation because of late-onset stent thrombosis, the actual incidence of stent thrombosis after 1 year is unknown. We investigated the incidence, risk factors, and association of antiplatelet therapy interruption for the development of stent thrombosis after DES implantation during long-term follow-up. A total of 1,911 consecutive patients with DES implantation were enrolled (sirolimus-eluting stents in 1,545 patients, 2,045 lesions; paclitaxel-eluting stents in 366 patients, 563 lesions). During long-term follow-up (median 19.4 months, interquartile range 15.3 to 24.3), 15 patients (0.8%, 95% confidence interval 0.5% to 1.3%) developed stent thrombosis within 6 hours to 20.4 months. Eleven patients (0.6%, 95% confidence interval 0.3% to 1.0%) had late thrombosis (median 6.1 months). The incidence of stent thrombosis was 3.3% (4 of 121 patients) in patients with complete interruption of antiplatelet therapy (vs 0.6% in those without, p = 0.004) and 7.8% (5 of 64 patients) with premature interruption of aspirin or clopidogrel, or both (vs 0.5% in those without, p <0.001). Independent predictors of stent thrombosis were premature antiplatelet therapy interruption, primary stenting in acute myocardial infarction, and total stent length. Stent thrombosis also developed while patients were on dual antiplatelet therapy (all patients with acute/subacute stent thrombosis and 36% of those with late stent thrombosis; 47% of total with stent thrombosis). In conclusion, stent thrombosis occurred in 0.8% after DES implantation during long-term follow-up. The incidence of late stent thrombosis was 0.6%, similar to that for bare metal stents. The predictors of stent thrombosis were premature antiplatelet therapy interruption, primary stenting in acute myocardial infarction, and total stent length.
Very Late Stent Thrombosis 11 Years after Implantation of a Drug-Eluting Stent
Texas Heart Institute Journal, 2015
Very late stent thrombosis is an infrequent yet potentially fatal complication associated with drug-eluting stents. We report the case of an 88-year-old man who sustained an ST-segment-elevation myocardial infarction 11 years after initial sirolimus-eluting stent implantation. Optical coherence tomograms of the lesion showed that the focal incomplete endothelialization of the stent struts was the likely cause; neointimal formation, neoatherosclerosis, and late stent malapposition might also have contributed. To our knowledge, this is the longest reported intervening period between stent insertion and the development of an acute coronary event secondary to very late stent thrombosis. The associated prognostic and therapeutic implications are considerable, because they illuminate the uncertainties surrounding the optimal duration of antiplatelet therapy in patients who have drug-eluting stents. Clinicians face challenges in treating these patients, particularly when competing medical demands necessitate the discontinuation of antiplatelet therapy. In addition to the patient's case, we discuss factors that can contribute to very late stent thrombosis.
Journal of The American College of Cardiology, 2005
We compared the risk of stent thrombosis (ST) after drug-eluting stents (DES) versus bare-metal stents (BMS), and tested the hypothesis that the risk of DES thrombosis is related to stent length. BACKGROUND Whether DES increase the risk of ST remains unclear. Given the very low restenosis rate after drug-eluting stenting, longer stents are frequently implanted for the same lesion length in comparison to BMS.
Stent Thrombosis in the Era of the Drug-Eluting Stent
Korean Circulation Journal, 2005
Coronary stent thrombosis (ST) has been regarded as a rare but catastrophic complication of bare-metal stent (BMS) implantation that normally occurs during the first few weeks after stenting. In the drug-eluting stent (DES) era, there has been increasing concern regarding higher rates of ST due to delayed endothelialization. However, a pooled meta-analysis of randomized clinical trials and registry studies showed rates of ST (0.4-1.5%) after DES to be similar to those of BMS. The rate of ST did not differ between sirolimus-and paclitaxel-eluting stents. Additionally, the rates of late ST were similar between DES and BMS. Remarkably, very late occurrence of ST, which develops up to 1-2 years after DES implantation, was significantly associated with complete cessation of antiplatelet therapy. Further large-scale studies are needed to determine the optimal combination and duration for antiplatelet therapy in order to prevent these serious thrombotic events.
Late stent thrombosis: the Damocle's sword of drug eluting stents?
EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology, 2007
As a result of the introduction of drug eluting stents (DES) to clinical practice, angiographic and clinical parameters of restenosis have been significantly improved. However, several recent publications have raised concerns about long-term safety of this technology. They include a potential risk of inducing chronic inflammation within the coronary artery, delayed healing and late stent thrombosis.Recently, late stent thrombosis, a rare but often life threatening event, has been reported to occur more frequently following DES placement. The mechanism of this phenomenon has not been fully elucidated.What is the true incidence of stent thrombosis after DES therapy? Is it similar or higher than with bare metal stents? Are randomised trials with DES therapy overestimating the benefits of this therapy? Which are the potential limitations of these studies? Are DES increasing rates of death and myocardial infarction from randomised trials and registries a true fact? In the following pages...