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Correlation of intravascular ultrasound findings with histopathological analysis of thrombus aspirates in patients
Stéphane Cook1, Elena Ladich, Gaku Nakazawa
1Invasive Cardiology, Department of Cardiology, University Hospital Bern, 3010 Bern, Switzerland.
Circulation
|July 22, 2009
Summary
Very late drug-eluting stent thrombosis is linked to inflammation and incomplete stent apposition. Eosinophils in thrombi correlate with stent malapposition, especially in sirolimus-eluting stents.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Biomaterials Science
Background:
- Intravascular ultrasound (IVUS) of drug-eluting stent (DES) thrombosis (ST) often shows incomplete stent apposition (ISA) and vessel remodeling.
- Autopsy findings in DES ST reveal delayed healing and hypersensitivity reactions.
- This study investigates the correlation between histopathology of thrombus aspirates and IVUS findings in very late DES ST.
Purpose of the Study:
- To correlate histopathological findings of thrombus aspirates with intravascular ultrasound (IVUS) findings in patients experiencing very late drug-eluting stent thrombosis (DES ST).
- To investigate the role of inflammation, specifically eosinophils, in the pathogenesis of very late DES ST.
- To compare the inflammatory profiles of very late DES ST with other causes of stent thrombosis and myocardial infarction.
Main Methods:
- Fifty-four patients were included: 28 with very late DES ST and 26 controls.
- Ten patients with very late DES ST underwent both thrombus aspiration and IVUS.
- Histopathological analysis of thrombus aspirates assessed inflammatory cells, including eosinophils, and correlated these findings with IVUS measurements of ISA and vessel remodeling.
Main Results:
- In very late DES ST, incomplete stent apposition (ISA) was present in 73% of cases, with significant vessel remodeling.
- Histopathology revealed fresh thrombus with inflammatory cell infiltrates and a notable presence of eosinophils.
- Eosinophil counts were significantly higher in very late DES ST compared to other myocardial infarction etiologies and correlated positively with ISA cross-sectional area.
Conclusions:
- Very late DES thrombosis is characterized by histopathological inflammation and IVUS-detected vessel remodeling.
- Eosinophilic infiltrates are more prevalent in thrombi from very late DES ST, particularly sirolimus-eluting stents, compared to other myocardial infarction causes.
- The extent of eosinophilic inflammation correlates with the degree of stent malapposition in very late DES ST.
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