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Pathologic Etiologies of Late and Very Late Stent Thrombosis following First-Generation Drug-Eluting Stent Placement
Joint Authors
Otsuka, Fumiyuki
Virmani, Renu
Kolodgie, Frank D.
Ladich, Elena
Nakano, Masataka
Source
Issue
Vol. 2012, Issue 2012 (31 Dec. 2012), pp.1-16, 16 p.
Publisher
Hindawi Publishing Corporation
Publication Date
2012-11-21
Country of Publication
Egypt
No. of Pages
16
Main Subjects
Abstract EN
Several randomized and observational studies have reported steady increase in cumulative incidence of late and very late ST (LST/VLST) following first-generation drug-eluting stents (DES: sirolimus-(SES) and paclitaxel-(PES)) up to 5 years.
Pathologic studies have identified uncovered struts as the primary substrate responsible for LST/VLST following DES, where delayed arterial healing is associated with stent struts penetrating into the necrotic core, long/overlapping stents, and bifurcation stenting especially in flow divider region.
Grade V stent fracture also induces LST/VLST and restenosis.
Hypersensitivity reaction is exclusive to SES as an etiology of LST/VLST, whereas malapposition secondary to excessive fibrin deposition is associated with PES.
Uncovered struts can be identified in SES and PES with duration of implant beyond 12 months, particularly in stents placed for “off-label” indications.
Neoatherosclerosis is another important contributing factor for VLST in DES and bare metal stents (BMS); however, DES shows rapid and more frequent development of neoatherosclerosis than BMS.
Future pathologic studies should address the long-term safety of newer generation DES including zotarolimus- and everolimus-eluting stents in terms of the improvement in reendothelialization, decreased inflammation and fibrin deposition as well as a lower incidence of stent fracture-related adverse events, and reduced neoatherosclerosis, which likely contribute to the decreased risk of LST/VLST and better patient outcomes.
American Psychological Association (APA)
Otsuka, Fumiyuki& Nakano, Masataka& Ladich, Elena& Kolodgie, Frank D.& Virmani, Renu. 2012. Pathologic Etiologies of Late and Very Late Stent Thrombosis following First-Generation Drug-Eluting Stent Placement. Thrombosis،Vol. 2012, no. 2012, pp.1-16.
https://search.emarefa.net/detail/BIM-484767
Modern Language Association (MLA)
Otsuka, Fumiyuki…[et al.]. Pathologic Etiologies of Late and Very Late Stent Thrombosis following First-Generation Drug-Eluting Stent Placement. Thrombosis No. 2012 (2012), pp.1-16.
https://search.emarefa.net/detail/BIM-484767
American Medical Association (AMA)
Otsuka, Fumiyuki& Nakano, Masataka& Ladich, Elena& Kolodgie, Frank D.& Virmani, Renu. Pathologic Etiologies of Late and Very Late Stent Thrombosis following First-Generation Drug-Eluting Stent Placement. Thrombosis. 2012. Vol. 2012, no. 2012, pp.1-16.
https://search.emarefa.net/detail/BIM-484767
Data Type
Journal Articles
Language
English
Notes
Includes bibliographical references
Record ID
BIM-484767