Predictors and outcomes of stent thrombosis: An intravascular ultrasound registry

Abstract

Aims: To investigate whether intravascular ultrasound provides additional information regarding the prediction of stent thrombosis, a retrospective multicentre registry was designed to enrol patients with stent thrombosis following stent deployment under ultrasound guidance. Methods and Results: A total of 53 patients were enrolled (mean age 61 ± 9 years) with stable angina (43%), unstable angina (36%), and post-infarct angina (21%) who underwent intracoronary stenting. The majority had balloon angioplasty alone prior to stenting (94%) with 6% also undergoing rotational atherectomy. The indication for stenting was elective (53%), suboptimal result (32%) and bailout (15%). There were 1.6 ± 0.8 stents/artery with 87% undergoing high-pressure dilatation (≥ 14 atmospheres). The minimum stent area was 7.7 ± 2.8 mm2 with a mean stent expansion of 81.5 ± 21.9%. Overall, 94% of cases demonstrated one abnormal ultrasound finding (stent under-expansion, malapposition, inflow/outflow disease, dissection, or thrombus). Angiography demonstrated an abnormality in only 32% of cases (chi-square= 30.0, P<0.001). Stent thrombosis occurred at 132 ± 125 h after deployment. Myocardial infarction occurred in 67% and there was an overall mortality of 15%. Conclusion: On comparison with angiography, the vast majority of stents associated with subsequent thrombosis have at least one abnormal feature by intravascular ultrasound at the time of stent deployment. © 2001 The European Society of Cardiology.