Peri-stent Contrast Staining Research Articles

Risk Factors and Clinical Impacts of Peri-Stent Contrast Staining After Second-Generation Drug-Eluting Stent Implantation.

Peri-stent contrast staining (PSS) after sirolimus-eluting stent implantation is associated with target lesion revascularization (TLR) and very late stent thrombosis. However, the risk factors and clinical sequelae of PSS after second-generation DES implantation remain unclear. This study comprised 2,090 patients with 2,883 lesions treated with second-generation DES from April 2009 to February 2013. Angiographic findings and clinical outcomes were compared between PSS and non-PSS groups. Follow-up angiography was available for 2,411 lesions. PSS was observed in 23 lesions: 4 in biolimus-eluting stents, 4 in zotarolimus-eluting stents (ZES), and 15 in everolimus-eluting stents (EES). Right coronary artery lesions, chronic total occlusion (CTO), and lesions with severe angulation (>90°) were more frequent in the PSS group compared with the non-PSS group. Lesions were longer and the cumulative TLR incidence at 3 years was higher in the PSS group than those in the non-PSS group (27.9 mm vs. 19.4 mm, P < 0.0001; 27.4% vs. 8.6%, P = 0.0002). There was no significant difference in stent thrombosis between the two groups. Multivariable analysis identified CTO [odds ratio (OR) 3.75, 95%CI 1.52-8.88, P = 0.005] as an independent predictor of PSS. PSS after second-generation DES implantation was associated with an increased risk of subsequent TLR. CTO was the independent predictor of PSS.

Abstract 10073: Characteristics of Very Late Stent Thrombosis Assessed by Coronary Angioscopy and Histopathology of Aspirated Thrombus

Background: The mechanisms of very late stent thrombosis (VLST) have not been fully elucidated and may involve multiple factors. The aim of this study was to evaluate characteristics of VLST based on angioscopy and histopathology of aspirated thrombus. Methods: Coronary angioscopy was performed in all stent thrombosis cases to evaluate the culprit lesion. The mechanisms of VLST were divided according to two factors by angioscopic findings such as uncovered struts and neoatherosclerosis. Uncovered struts were defined as stent struts uncovered by neointima. Neoatherosclerosis was defined as stent struts covered by yellow neointima. Furthermore, aspirated material was collected for assessment of atherothrombotic characteristics in all cases. Results: From February 2011 to April 2015, emergency PCI for acute myocardial infarction was performed in 336 patients, with 13 of these cases due to stent thrombosis. Clinical characteristics of VLST patients are shown in Figure. In uncovered struts, all 3 cases were not on any antiplatelet therapy prior to VLST, whereas patients with neoatherosclerosis were taking at least one antiplatelet agents except for one case. In the presence of neoatherosclerosis, thrombus with atheroma material was aspirated in 5 of 10 cases despite there was no atheroma material in patients with uncovered strut. The time period of occurrence of VLST was significantly shorter in patients with uncovered strut compared with neoatherosclerosis (48.6±12.5 month vs. 84.3±6.9 month, p=0.03) In 13 case of VLST, peri stent contrast staining (PSS) was found in 1 case of each neoatherosclerosis and uncovered strut at the time of follow-up angiography. Conclusions: Discontinuation of dual anti platelet therapy was an important predictor for VLST, especially in patients with uncovered struts. However, most VLST weredue to neoatherosclerotic plaque rupture assessed by coronary angioscopy, which were also confirmed by histopathology of aspirated thrombus.

THE ASSOCIATION BETWEEN PROGRESSIVE PERI-STENT CONTRAST STAINING, MAJOR ADVERSE CARDIAC EVENTS, AND VERY LATE STENT THROMBOSIS IN PATIENTS AFTER STENT IMPLANTATION

Peri-stent contrast staining (PSS) is reported to be associated with subsequent target lesion revascularization (TLR) and very late stent thrombosis (VLST). However, the association between the temporal change of PSS and subsequent clinical events is little known. We performed percutaneous coronary

INCIDENCE AND CLINICAL IMPLICATIONS OF PERI-STENT CONTRAST STAINING IN VARIOUS TYPES OF DRUG-ELUTING STENT

Peri-stent contrast staining (PSS) was defined as contrast staining outside the stent contour extending to ≥20% of the stent diameter. PSS could be related to stent fracture (SF) , in-stent restenosis (ISR) and very late stent thrombosis. We evaluated the prevalence and clinical implications of

Association of localized hypersensitivity and in-stent neoatherosclerosis with the very late drug-eluting stent thrombosis.

BackgroundLocalized hypersensitivity reaction, delayed arterial healing, and neoatherosclerosis inside the stent have been suggested as the underlying pathologic mechanisms of very late stent thrombosis (VLST) of drug-eluting stent (DES). The present study sought to explore the prevalence of inflammatory cell infiltrates and evidence for fragments of atherosclerotic plaques in the aspirated thrombi in patients with DES VLST.Methods and ResultsFrom April 2004 to September 2012, 48 patients with stent thrombosis (ST) of DES underwent thrombus aspiration with retrieved material sufficient for the histopathologic analysis; early ST (EST, within 30 days): N = 17, late ST (LST, between 31 and 365 days): N = 7, and very late ST (VLST, >1 year): N = 24. Eosinophil fraction in the aspirated thrombi was significantly higher in patients with VLST (8.2±5.7%) as compared with those with EST (4.3±3.0%) and LST (5.5±3.8%) (P = 0.03). Eosinophil fraction in the aspirated thrombi was significantly higher in 12 VLST patients with angiographic peri-stent contrast staining (PSS) and/or incomplete stent apposition (ISA) by intravascular ultrasound than in 12 VLST patients without PSS or ISA (10.6±6.1% versus 5.8±4.1%, P = 0.03). Evidences for fragments of atherosclerotic plaques in the aspirated thrombi were observed only in 3 (13%) out of 24 patients with DES VLST.ConclusionsEosinophil fraction in the aspirated thrombi was significantly higher in patients with DES VLST as compared with those with EST and LST. Evidences for fragments of atherosclerotic plaques were relatively uncommon in patients with DES VLST.

Very late acquired peri-stent contrast staining and incomplete stent apposition with biodegradable polymer stents: Insight from optical coherence tomography

Very late acquired peri-stent contrast staining and incomplete stent apposition with biodegradable polymer stents: Insight from optical coherence tomography

Clinical use of optical coherence tomography to identify angiographic silent stent thrombosis

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 first-generation drug-eluting stents (DES). Results. The first 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 findings 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 fibrin deposition, inflammatory 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 findings may impact the treatment strategy in these patients.

Impact of angiographic peri-stent contrast staining (PSS) on late adverse events after sirolimus-eluting stent implantation: an observation from the multicenter j-Cypher registry PSS substudy

This study sought to assess clinical significance of angiographic peri-stent contrast staining (PSS) after sirolimus-eluting stent (SES) implantation in a large multicenter study with 5-year follow-up. The j-Cypher PSS substudy is a multicenter study including 5712 patients (7838 lesions) who underwent follow-up angiographic study within 12months after SES implantation. Late acquired PSS was observed in 184 patients (3.2%) or 194 lesions (2.5%). Independent risk factors of PSS were chronic total occlusion and left anterior descending artery lesion, while negative risk factors were in-stent restenosis, diabetes mellitus, ≥70years of age, and left circumflex coronary artery lesion. Cumulative incidence of definite very late stent thrombosis (VLST) at 4years after the index follow-up angiography in lesions with PSS was significantly higher than that in lesions without PSS (5.3 versus 0.7%, P<0.0001). Late target-lesion revascularization (TLR) was also more frequently observed in the PSS group (13 versus 6.9%, P=0.01), while late TLR for restenosis excluding those TLR procedures for VLST tended to be higher in the PSS group (9.9 versus 6.3%; P=0.15). PSS found in 2.5% of lesions within 12months after SES implantation was associated with higher risk for subsequent VLST.

Two peri-stent contrast stainings and one late restenosis in the late phase after sirolimus-eluting stent implantation

Both peri-stent contrast staining (PSS) and late restenosis are abnormal findings after drug-eluting stent implantation and they occur with low incidence. We describe a case with two PSSs and one late restenosis after sirolimus-eluting stent implantation. Persistent high value of C-reactive protein in this patient suggested chronic systematic inflammation as a contributing factor of these abnormal findings.<Learning objective: The advent of drug-eluting stents has dramatically reduced in-stent restenosis. However, there are still some concerns about long-term safety. We show a case with multiple sirolimus-eluting stent-related complications, taking into account the underlying pathogenesis.>

Everolimus eluting stent留置後にperi-stent contrast stainingを認めた1例

Everolimus eluting stent留置後にperi-stent contrast stainingを認めた1例

Angioscopic Assessment of Peri-Stent Contrast Staining Following Drug-Eluting Stent Implantation

Peri-stent contrast staining (PSS) has been recognized as a predictor of late stent thrombosis following drug-eluting stent (DES) implantation. However, the intravascular conditions at PSS sites remain unclear. We evaluated 10 patients (median age 72 years, 80% male) with stable angina pectoris by coronary angioscopy. The patients had a total of 11 DES implantations (5 sirolimus-eluting stents; 4 paclitaxel-eluting stents; 2 everolimus-eluting stents) that showed PSS. Neointimal coverage (NIC), presence of thrombus, and yellow plaques underneath the stent were compared between PSS and non-PSS sites for each stent. NIC was graded as: grade 0, struts exposed; grade 1, struts bulging into the lumen, although covered; grade 2, struts embedded by neointima, but translucent; grade 3, struts fully embedded and invisible. Mean follow-up was 394±206 days (median: 289). NIC grade was lower at PSS sites (P=0.021) with 8 out of 11 stents (73%) having grade 0. Angioscopy detected a thrombus more frequently at PSS sites than at non-PSS sites (64% vs. 9%, P=0.012). Yellow plaques tended to be more significant at PSS sites than at non-PSS sites (82% vs. 45%, P=0.091). The angioscopic findings suggest high thrombogenicity at PSS sites.

Unusual peri-stent strut contrast staining 6 years after sirolimus-eluting stent implantation: an “ant colony-like” appearance

A 60-year-old man with a previous history of sirolimus-eluting stent implantation was admitted because of chest pain. Coronary angiography revealed nonsignificant in-stent luminal narrowing at the previously stented segment with an unusual linear peri-stent strut contrast staining. Frequency-domain optical coherence tomography showed a cavity at the segment connecting to the coronary lumen at the distal part of the stent. This unusual "ant-colony"-like appearance of the stented segment may be a subtype of the incomplete stent apposition and/or interstrut hollows.

Peri-stent contrast staining and very late stent thrombosis after sirolimus-eluting stent implantation: an observation from the RESTART (REgistry of Stent Thrombosis for review And Re-evaluaTion) angiographic substudy

The aim of the study was to clarify the angiographic characteristics of stent thrombosis (ST) in relation to sirolimus-eluting stents (SES). RESTART is a Japanese registry of SES-associated ST. As an angiographic substudy, coronary angiograms at baseline, at six to 12 months and at the time of ST were analysed. Angiograms of 313 patients (early ST [EST] 169 patients, late ST [LST] 59 patients, and very late ST [VLST] 85 patients) were investigated. Residual dissection post procedure was more frequently seen in the EST group. Stent fracture was more frequently seen in the VLST group than in the EST and LST groups (16.5%, 3.0%, and 3.4%, respectively; p<0.001). Peri-stent contrast staining (PSS), defined as contrast staining outside the stent contour extending to ≥20% of the stent diameter, was remarkably more prevalent in the VLST group than in the EST and LST groups (34.1%, 4.7%, and 6.8%, respectively; p<0.001). Abnormal angiographic findings such as PSS and stent fracture were found significantly more frequently in lesions with VLST than in lesions with EST and LST.

TCT-462 The difference in Temporal Change of Peri-stent Contrast Staining Between Drug-eluting Stent and Bare-metal Stent

TCT-462 The difference in Temporal Change of Peri-stent Contrast Staining Between Drug-eluting Stent and Bare-metal Stent

A case report of very late stent thrombosis observed simultaneously in all three vessels 5 years after sirolimus-eluting stent implantation

A 67-year-old man with recent myocardial infarction underwent a total of five sirolimus-eluting stents (SES) implantation for three vessels stage by stage. A follow-up angiography showed no significant restenosis except one in the side branch. Thereafter, he had remained asymptomatic. Sixty-six months later, he had an acute myocardial infarction with cardiogenic shock due to simultaneous 3-vessel very late stent thrombosis (VLST). After successful percutaneous coronary intervention, final angiography revealed serious peri-stent contrast staining along with positive remodeling and grade V stent fracture. This rare case illustrates simultaneous 3-vessel VLST, associating with multiple SES-related problems, under continuation of aspirin and cilostazol.

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

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

The relationship between peri-stent contrast staining and positive remodeling after sirolimus-eluting stent implantation assessing with intravascular ultrasound and optical coherence tomography

Purpose: It was reported that peri-stent contrast staining (PSS) was one of abnormal vessel reactions including incomplete stent apposition (ISA) and multiple interstrut hollows (MIH) assessed with optical coherence tomography (OCT), meanwhile positive vessel remodeling could be regarded as one of mechanisms of ISA. The aim of this study was to clarify the relationship between PSS and positive remodeling. Methods: Between May 2008 and February 2010, we performed IVUS and OCT for 56 in-stent restenosis lesions after sirolimus-eluting stent implantation. We found PSS in 19 of the 56 lesions by coronary angiography. We examined the difference in IVUS parameters including external elastic membrane (EEM) area and remodeling index (RI) at PSS site between lesions with PSS and those without PSS. PSS is defined as contrast staining outside the stent contour extending to >20% of the stent diameter measured by quantitative coronary angiography. ISA was defined as separation of at least 1 stent strut from the vessel wall which is not related to a side branch, and MIH is defined as multiple hollows (the maximum depth >0.5 mm) existing between and outside well-apposed stent struts, assessed with OCT. The remodeling index (RI) was defined as the ratio of EEM area at PSS site to that at the proximal reference site, assessed with IVUS. Positive remodeling was defined as RI >1.05. Furthermore, we examined the difference in EEM area and RI at lesion site between lesions with and without ISA and MIH. Results: Patients were 45 men and 11 women, and the mean age was 70.1±8.3 years. The results are shown in the figure. ![Figure][1] The results assessed with IVUS and OCT Conclusions: PSS might be closely associated with the existence of positive remodeling, ISA, and MIH. [1]: pending:yes

The association between incomplete stent apposition, multiple interstrut hollows, and in-stent thrombus formation in lesions after drug-eluting stent implantation

Purpose: Incomplete stent apposition (ISA) assessed with intravascular ultrasound was known as one of risk factors for stent thrombosis. Meanwhile it was reported that peri-stent contrast staining (PSS) was associated with very late stent thrombosis, and was also reported that ISA and multiple interstrut hollows (MIH) were observed in the lesions with PSS using optical coherence tomography (OCT). However, little is known about the association between ISA, MIH, and in-stent thrombus formation in lesions after drug-eluting stent (DES) implantation. Methods: Between May 2008 and January 2013, we performed OCT for 328 in-stent restenosis lesions after DES implantation. Cross-sectional OCT images were analyzed at every 1 mm of the stented site and qualitative assessment of existence of ISA, MIH, and thrombus was performed. ISA was defined as separation of at least 1 stent strut from the vessel wall, and MIH is defined as multiple hollows (the maximum depth >0.5 mm) existing between and outside well-apposed stent struts. The difference in the incidence of in-stent thrombus formation was compared between lesions with and without ISA and MIH. Thrombus was defined as masses protruding into the vessel lumen with a dimension >250 μm. Red thrombus was high-backscattering protrusion with high attenuation. White thrombus was signal-rich low backscattering protrusion with low attenuation. Results: The patients were 271 men and 57 women and the mean age was 68.9±9.4 years. The mean follow-up period from stent implantation was 1.62±1.53 years. The results are shown in the figure. ![Figure][1] Figure 1 Conclusion: ISA assessed with OCT might to be one of risk factors for in-stent thrombus formation in restenosis lesions after DES implantation. MIH might have an effect on only the formation of red thrombus. [1]: pending:yes

Evaluation of peri-stent contrast staining and stent fracture after sirolimus-eluting stent implantation by dual source computed tomography

Evaluation of peri-stent contrast staining and stent fracture after sirolimus-eluting stent implantation by dual source computed tomography

Angiographic findings of everolimus-eluting as compared to sirolimus-eluting stents: angiographic sub-study from the Randomized Evaluation of Sirolimus-eluting versus Everolimus-eluting stent Trial (RESET)

Several recent randomized trials comparing everolimus-eluting stent (EES) and sirolimus-eluting stent (SES) reported similar clinical outcomes. This study was aimed to clarify the differences in the angiographic findings of EES as compared to SES. Randomized Evaluation of Sirolimus-eluting versus Everolimus-eluting stent Trial is a prospective multicenter randomized open-label trial comparing EES with SES in Japan. From February to July 2010, 3197 patients were randomly assigned to receive either EES or SES. Of these, angiographic sub-study enrolled 571 patients (EES 285 patients, SES 286 patients). Angiograms were assessed qualitatively and quantitatively at procedure and at 8-12 months in the independent core angiographic laboratory. Late loss of the proximal edges tended to be greater in the EES group than that in the SES group (0.12 ± 0.49 vs. 0.04 ± 0.43 mm, P = 0.05), although late loss in the other segments was similar between the 2 groups. Edge restenosis was mainly observed in EES group, whereas body restenosis was demonstrated in half of SES group. Stent fracture was observed only in the SES group (1.5 %), and peri-stent contrast staining (PSS) tended to be more frequently observed in the SES group than in the EES group (3.6 and 1.5 %, P = 0.18). Restenotic response in the proximal edge was more prominent in the EES group as compared to the SES group. Abnormal angiographic findings such as stent fracture and PSS tended to be more frequent in the SES group.