Abstract 2776: Intravascular Ultrasound Guidance: Angiographic and Procedural Correlates of Stent Thrombosis After Intracoronary Implantation of Drug-Eluting Stents
Background: Stent thrombosis (ST) following the implantation of drug-eluting stents (DES) remains the major limitation of this new technology. The purpose of this study was to detect angiographic and procedural correlates of ST.
Methods: Retrospective lesion-based study. A cohort of 54 consecutive lesions (35 patients) initially treated with successful DES implantation from May 2003 to February 2005 that re-presented with ST within 12 months was identified. This group was compared to a control group of 1620 consecutive unselected lesions (1150 patients) that were successfully treated with DES implantation which remained free of ST. Comparison of angiographic and procedural features was made between the ST and no-ST groups and logistic regression analysis was then performed to identify independent correlates of ST. For the purposes of the study only definite ST events (angiographically or autopsy proven) were considered.
Results: Correlates of ST by multivariate analysis included both angiographic and procedural factors. Angiographic correlates were left anterior descending artery, bifurcation lesions, and vessel caliber. Procedural predictors were number of stents per lesion (OR 2.38, CI 1.19 – 4.77 P = 0.015) and intravascular ultrasound (IVUS) guidance (OR 0.53 CI 0.29 – 0.95 P = 0.033). The benefit of IVUS guidance was in the prevention of subacute ST with little impact on late events. The rate of clopidogrel withdrawal in patients presenting with ST was not significantly different between patients undergoing IVUS guided PCI and those not.
Conclusions. Optimizing stent implantation with IVUS guidance and restricting the number of stents utilized may prevent ST in the DES era. The benefit of IVUS guidance was in the prevention of subacute ST with little impact on late events.