Abstract
Objectives: We examined characteristics of lesions in cases of intraprocedural stent thrombosis (IPST) using intravascular ultrasound (IVUS). Background: IPST is a rare complication occurring during percutaneous coronary intervention (PCI) that leads to poor outcomes. However, factors that contribute to IPST remain largely unknown. Methods: We retrospectively analyzed 1,504 consecutive stent-implanted lesions in 1,324 patients [326 with ST-segment elevation myocardial infarction (STEMI), 403 with non-ST-segment elevation acute coronary syndrome (NSTE-ACS), and 595 with stable angina]. IVUS characteristics of plaques that led to IPST were compared with those of a matched control (non-IPST) group (n = 15) without evidence of IPST matched by age; gender; lesion location; or STEMI, NSTE-ACS, or stable angina. Positive remodeling was defined as a lesion greater than the mean reference external elastic membrane cross-sectional area. Continuous variables were displayed as median and 1st and 3rd interquartile range. Results: IPST occurred in 5 (0.4%; 3 with STEMI, 2 with NSTE-ACS) of 1,324 patients during PCI. Plaque burden at the minimum lumen area site was significantly greater in the IPST group than in the non-IPST group (93.0% vs. 87.9%, P = 0.0035). All 5 culprit lesions that led to IPST had ruptured plaques with positive remodeling and attenuation. The maximum cavity area was larger in the IPST group than in the non-IPST group (4.6 [4.3, 6.5] mm2 vs. 0 [0, 1.9] mm2, P = 0.0011), whereas plaque rupture was also observed in 40% of subjects in the non-IPST group. Multiple plaque ruptures in the culprit lesion were far more common in the IPST group (80.0% vs. 6.7%, P = 0.0049). Conclusion: Multiple plaque ruptures and a larger cavity area were associated with IPST occurrence. IVUS assessment may help predict the development of IPST during PCI.
Published Version
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