Clincal use of optical coherence tomography to identify angiographic silent stent thrombosis
Permanent link
https://hdl.handle.net/10037/6519Date
2014Type
Journal articleTidsskriftartikkel
Peer reviewed
Author
Steigen, Sonja Eriksson; Holm, Niels R.; Butt, Noreen; Maeng, Michael; Otsuka, Fumiyuki; Virmani, Renu; Ladich, Elena; Steigen, TerjeAbstract
Objectives. Patients previously treated with coronary stents may suffer an acute coronary syndrome (ACS) without any
evidence of thrombus formation on coronary angiography (CAG). This may be due to partial, nonocclusive stent thrombosis
with microembolization. In this paper, we illustrate possible mechanisms both with optical coherence tomography
(OCT) and histology. Design. We present two cases with ACS from very late stent thrombosis who have been previously
treated with fi rst-generation drug-eluting stents (DES). Results. The fi rst patient had ACS 15 months after DES implantation.
The angiogram (CAG) was near normal with slight peri-stent contrast staining. OCT revealed abnormalities
including thrombus not visible on CAG. These are fi ndings that may explain the ACS. The second patient had subclinical
episodes with chest pain after DES implantation. The patient died from stent thrombosis in a DES. Postmortem histological
examination of the coronary arteries revealed stent struts with little or no neointimal coverage, persistent peri-strut
fi brin deposition, infl ammatory cells, malapposition, and small luminal platelet-rich thrombi. Old spotty myocardial
infarctions were found in the supplied territory possibly caused by earlier episodes of embolizing thrombus. Conclusions.
In patients with previous implanted DES presenting with ACS, OCT may detect abnormalities and thrombus formation
not visible on CAG. Such fi ndings may impact the treatment strategy in these patients.
Publisher
Informa healthcareCitation
Scandinavian Cardiovascular Journal 48(2014) s. 156-160Metadata
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