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J Am Coll Cardiol, 2005; 45:995-998, doi:10.1016/j.jacc.2004.12.066
© 2005 by the American College of Cardiology Foundation
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CLINICAL RESEARCH: INTERVENTIONAL CARDIOLOGY

Stent underexpansion and residual reference segment stenosis are related to stent thrombosis after sirolimus-eluting stent implantation

An intravascular ultrasound study

Kenichi Fujii, MD, Stéphane G. Carlier, MD, PhD*, Gary S. Mintz, MD, Yi-ming Yang, MD, Issam Moussa, MD, Giora Weisz, MD, George Dangas, MD, PhD, Roxana Mehran, MD, Alexandra J. Lansky, MD, Edward M. Kreps, MD, Michael Collins, MD, Gregg W. Stone, MD, Jeffrey W. Moses, MD and Martin B. Leon, MD

Columbia University Medical Center and Cardiovascular Research Foundation, New York, New York

Manuscript received November 10, 2004; revised manuscript received December 14, 2004, accepted December 21, 2004.

* Reprint requests and correspondence: Dr. Stéphane G. Carlier, Cardiovascular Research Foundation, Intravascular Imaging and Physiology, 55 East 59th Street, 6th floor, New York, New York 10022 (Email: scarlier{at}crf.org).

OBJECTIVES: We sought to determine the predictors of stent thrombosis after sirolimus-eluting stent (SES) implantation.

BACKGROUND: A number of cases of stent thrombosis have been reported after commercial release of the SES in the "real world," such that the U.S. Food and Drug Administration issued a warning.

METHODS: Fifteen patients who developed stent thrombosis after successful SES implantation were analyzed and compared with 45 matched control patients who had no evidence of stent thrombosis.

RESULTS: Minimum stent cross-sectional area (MSA) (4.3 ± 1.6 mm2 vs. 6.2 ± 1.9 mm2, p < 0.001) and stent expansion (0.65 ± 0.18 vs. 0.85 ± 0.14, p < 0.001) were significantly smaller in the stent thrombosis group than in the matched control patients. There was no significant difference in the rate of SES malapposition between the groups. However, the presence of a significant residual reference segment stenosis was more common in the stent thrombosis group compared with the matched control group (67% vs. 9%, p < 0.001). Independent predictors of stent thrombosis were stent underexpansion (p = 0.03) and a significant residual reference segment stenosis (p = 0.02).

CONCLUSIONS: Stent underexpansion and residual reference segment stenosis are associated with stent thrombosis after successful SES implantation.

Abbreviations and Acronyms
  CSA = cross-sectional area
  EEM = external elastic membrane
  IVUS = intravascular ultrasound
  MSA = minimum stent cross-sectional area
  SES = sirolimus-eluting stent




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