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Late drug-eluting stent thrombosis: importance of intravascular ultrasound
Authors:Andrew McCann  Andrew MacIsaac  Robert J Whitbourn
Institution:1. Department of Internal Medicine, Rhode Island Hospital, Brown University, JB 0100, 593 Eddy Street, Providence, RI 02903, USA;2. Division of Hematology/Oncology, Rhode Island Hospital, Brown University, 593 Eddy Street, Providence, RI 02903, USA;1. Department of Oncology, University of Torino, 10126 Torino, Italy;2. Institute for Molecular Cell Biology, Center for Molecular Biomedicine, Friedrich Schiller University of Jena, 07745 Jena, Germany;3. Nurex srl, 07100 Sassari, Italy;1. Office of Vice President for Clinical Research, University of Texas MD Anderson Cancer Center, Houston, TX, USA;2. Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA;3. Department of Medical Affairs, University of Texas MD Anderson Cancer Center, Houston, TX, USA;4. Department of Health Sciences Research, Mayo Clinic, Rochester, MD, USA;5. Department of Surgery, Mayo Clinic, Rochester, MD, USA;6. Department of Surgery University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA;7. Division of Medical Oncology, Washington University School of Medicine, St Louis, MO, USA;8. Doctors Hospital of Laredo, Laredo, TX, USA;9. Department of Internal Medicine, University of New Mexico Cancer Center, Albuquerque, NM, USA;10. Alliance Statistics Center, Duke University Cancer Institute, Durham, NC, USA;1. School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania;2. School of Nursing, Vanderbilt University, Nashville, Tennessee;3. Department of Biostatistics, School of Medicine, Vanderbilt University, Nashville, Tennessee;4. Vanderbilt-Ingram Cancer Center, Vanderbilt Medical Center, Nashville, Tennessee
Abstract:We report two cases of late occurring drug-eluting stent thrombosis (ST) where coronary angiography failed to identify the cause but intravascular ultrasound (IVUS) revealed underlying mechanical problems with the initial stent deployment. Mechanical factors such as stent underexpansion and residual edge stenoses may be more important in the pathogenesis of late drug-eluting ST than previously recognized. Intravascular ultrasound is required to reliably detect these problems and optimize subsequent reintervention.
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