Characteristics of angiographic Peri-Stent contrast Staining (PSS) on very late stent thrombosis after sirolimus-eluting stent implantation: morphological classification and antiplatelet therapy

Abstract

Backgrounds: We previously reported that Peri-Stent contrast Staining (PSS) after Sirolimus-Eluting Stent (SES) was associated with subsequent Very Late Stent Thrombosis (VLST) in a cohort with larger number of patients and longer follow-up duration. However, real clinical characteristics of PSS on VLST remain unknown due to the small numbers of patients with PSS. Methods and results: The j-Cypher PSS substudy included 5712 patients (7838 lesions) with angiographic follow-up within 12 months after SES implantation in 19 participating centers. Late acquired PSS without TLR within 12 months was observed in 174 patients (3.3%) or 183 lesions (2.5%). We found association between VLST and morphologic classification of PSS, 6 out of 8 cases of VLST was segmental types of PSS. Progressive increase in the severity of PSS over time before the onset of VLST was observed in 4 lesions out of 8 lesions with VLST and PSS. Among patients with PSS, those patients who had subsequent VLST were less often had hypertension than those patients without subsequent VLST. Among lesions with PSS, lesion length was significantly longer in lesions with VLST than in lesions without VLST. In patients with PSS finding within the first year, cumulative incidence of VLST through 4 years after the index follow-up angiography was not significantly different between the 2 groups of patients either on or off thienopyridine at 1 year after initial SES implantation. ![Figure][1] Conclusions: Progressive increase in the severity of PSS over time and segmental types of PSS was associated with higher risks for subsequent VLST. Either on or off thienopyridine at 1 year after initial SES implantation was not associated with VLST in the patients with PSS. [1]: pending:yes