Abstract

Aims To investigate whether intravascular ultrasound provides additional information regarding the prediction of stent thrombosis, a retrospective multicentre registry was designed to enrol patients with stent thrombosis following stent deployment under ultrasound guidance.

Methods and Results A total of 53 patients were enrolled (mean age 61±9 years) with stable angina (43%), unstable angina (36%), and post-infarct angina (21%) who underwent intracoronary stenting. The majority had balloon angioplasty alone prior to stenting (94%) with 6% also undergoing rotational atherectomy. The indication for stenting was elective (53%), suboptimal result (32%) and bailout (15%). There were 1·6±0·8 stents/artery with 87% undergoing high-pressure dilatation (≥14 atmospheres). The minimum stent area was 7·7±2·8mm2with a mean stent expansion of 81·5±21·9%. Overall, 94% of cases demonstrated one abnormal ultrasound finding (stent under-expansion, malapposition, inflow/outflow disease, dissection, or thrombus). Angiography demonstrated an abnormality in only 32% of cases (chi-square=30·0,P <0·001). Stent thrombosis occurred at 132±125h after deployment. Myocardial infarction occurred in 67% and there was an overall mortality of 15%.

Conclusion On comparison with angiography, the vast majority of stents associated with subsequent thrombosis have at least one abnormal feature by intravascular ultrasound at the time of stent deployment.

f1
Correspondence: Neal Uren MD MRCP FESC, Department of Cardiology, Royal Infirmary, 1 Lauriston Place, Edinburgh EH3 9YW, U.K.

References

1
Colombo
A
, Hall P, Nakamura S. Intravascular stenting without anticoagulation accomplished with intravascular ultrasound guidance.
Circulation
 .
1995
;
91
:
1891
–1893
2
Karrillon
GJ
, Morice MC, Beneviste E. Intracoronary stent implantation without ultrasound guidance and with replacement of conventional anticoagulation by antiplatelet therapy: 30 day clinical outcome of the French multicenter registry.
Circulation
 .
1996
;
94
:
1519
–1527
3
Hall
P
, Nakamura S, Maiello L. A randomized comparison of combined ticlopidine and aspirin therapy versus aspirin therapy alone after successful intravascular ultrasound-guided stent implantation.
Circulation
 .
1996
;
93
:
215
–222
4
Schömig
A
, Neumann F-J, Kastrati A. A randomized comparison of antiplatelet and anticoagulant therapy after the placement of coronary-artery stents.
N Engl J Med
 .
1996
;
334
:
1084
–1089
5
Serruys
PW
, van Hout B, Bonnier H. Randomised comparison of implantation of heparin-coated stents with balloon angioplasty in selected patients with coronary artery disease (Benestent II).
Lancet
 .
1998
;
352
:
673
–681
6
de Jaegere
P
, Mudra H, Figulla H. Intravascular ultrasound-guided optimized stent deployment. Immediate and 6 months clinical and angiographic results from the Multicenter Ultrasound Stenting in Coronaries Study (MUSIC study).
Eur Heart J
 .
1998
;
19
:
1214
–1223
7
Metz
JA
, Mooney MR, Walter PD. Significance of edge tears in coronary stenting: initial observations from the STRUT registry (Abstr).
Circulation
 .
1995
;
92
:
I-546
8
Fitzgerald
PJ
, Oshima A, Hayase M. Final results of the Can Routine Ultrasound Influence Stent Expansion (CRUISE) study?
Circulation
 .
2000
;
102
:
523
–530
9
Russo
RJ
, Attubato MS, Davidson CJ. Angiography versus intravascular ultrasound-directed stent placement: final results from AVID (Abstr).
Circulation
 .
1999
;
100
:
I-234
10
Barragan
P
, Sainsous J, Silvestri M. Ticlopidine and subcutaneous heparin as an alternative regimen following coronary stenting.
Cathet Cardiovasc Diag
 .
1994
;
32
:
133
–138
11
Morice
MC
, Zemour G, Beneviste E. Intracoronary stenting without coumadin: one month results of a French multicenter study.
Cathet Cardiovasc Diag
 .
1995
;
35
:
1
–7
12
Nakamura
S
, Colombo A, Gaglione S. Intracoronary ultrasound observations during stent implantation.
Circulation
 .
1994
;
89
:
2026
–2034
13
Goldberg
Sl
, Colombo A, Nakamura S, Almagor Y, Maiello L, Tobis JM. The benefit of intracoronary ultrasound in the deployment of Palmaz–Schatz stents.
J Am Coll Cardiol
 .
1994
;
24
:
996
–1003
14
Moussa
I
, di Mario C, Reimers B, Akiyama T, Tobis J, Colombo A. Subacute stent thrombosis in the era of intravascular ultrasound-guided coronary stenting without anticoagulation: frequency, predictors, and clinical outcome.
J Am Coll Cardiol
 .
1997
;
29
:
6
–12
15
Nath
FC
, Muller DWM, Ellis SG. Thrombosis of flexible coil coronary stent: frequency, predictors and clinical outcome.
J Am Coll Cardiol
 .
1993
;
21
:
622
–627
16
Agrawal
LS
, Ho D, Liu M, Iser S. Predictors of thrombotic complications after placement of the flexible coil stent.
Am J Cardiol
 .
1994
;
73
:
1216
–1221
17
Werner
GS
, Gastmann O, Ferrari M. Risk factors for acute and subacute stent thrombosis after high-pressure stent implantation: a study by intracoronary ultrasound.
Am Heart J
 .
1998
;
135
:
300
–309
18
Schühlen
H
, Hadamitzky M, Walter H, Ulm K, Schömig A. Major benefit from antiplatelet therapy for patients at high risk for adverse cardiac events after coronary Palmaz–Schatz stent placement: analysis of a prospective risk stratification protocol in the Intracoronary Stenting and Antithrombotic Regimen (ISAR) trial.
Circulation
 .
1997
;
95
:
2015
–2021
19
Schühlen
H
, Kastrati A, Dirschinger J. Intracoronary stenting and risk for major adverse cardiac events during the first month.
Circulation
 .
1998
;
98
:
104
–111
20
Costa
MA
, Sabaté M, van der Giessen WJ. Late coronary occlusion after intracoronary brachytherapy.
Circulation
 .
1999
;
100
:
789
–792

Comments

0 Comments