Incidence and Morphological Predictors of Intrastent Coronary Thrombus After Drug-Eluting Stent Implantation (from a...

Area of Science:

• Cardiovascular Research
• Interventional Cardiology
• Biomedical Engineering

Background:

• Late stent thrombosis (LST) after drug-eluting stent (DES) implantation remains a significant clinical concern.
• Mechanisms underlying LST and very late stent thrombosis (VLST) require further elucidation.
• Optical coherence tomography (OCT) offers high-resolution imaging for detailed vascular morphology assessment.

Purpose of the Study:

• To determine the incidence of intrastent thrombus in patients undergoing follow-up OCT >6 months post-DES implantation.
• To identify morphologic predictors of intrastent thrombus formation.
• To compare outcomes between first-generation and second-generation DES regarding thrombosis and arterial healing.

Main Methods:

• Retrospective analysis of 262 DES in 208 patients with follow-up OCT >6 months post-implantation.
• Detailed assessment of vascular morphology, including neointimal characteristics and strut visualization.
• Comparison of morphologic parameters and thrombus incidence between patients with and without intrastent thrombus.

Main Results:

• Intrastent thrombus was detected in 11.5% of patients at a median of 11 months post-DES.
• Smaller minimal lumen cross-sectional area was significantly associated with thrombus presence (2.9 vs 4.6 mm²).
• Thin-cap fibroatheroma and heterogeneous neointima were more prevalent in the thrombus group; second-generation DES showed lower thrombus incidence.

Conclusions:

• Reduced lumen cross-sectional area and specific neointimal morphologies are key predictors of intrastent thrombus.
• Second-generation DES exhibit improved arterial healing and a reduced risk of intrastent thrombosis compared to first-generation DES.
• OCT imaging is crucial for understanding the mechanisms of late stent thrombosis and evaluating stent performance.