Correlation of intravascular ultrasound findings with histopathological analysis of thrombus aspirates in patients with very late drug-eluting stent thrombosis

Cook, Stéphane; Ladich, Elena; Nakazawa, Gaku; Eshtehardi, Parham; Neidhart, Michel; Vogel, Rolf; Togni, Mario; Wenaweser, Peter; Billinger, Michael; Seiler, Christian; Gay, Steffen; Meier, Bernhard; Pichler, Werner J; Jüni, Peter; Virmani, Renu; Windecker, Stephan (2009). Correlation of intravascular ultrasound findings with histopathological analysis of thrombus aspirates in patients with very late drug-eluting stent thrombosis. Circulation, 120(5), pp. 391-399. Baltimore, Md.: Lippincott Williams & Wilkins 10.1161/CIRCULATIONAHA.109.854398

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BACKGROUND: Intravascular ultrasound of drug-eluting stent (DES) thrombosis (ST) reveals a high incidence of incomplete stent apposition (ISA) and vessel remodeling. Autopsy specimens of DES ST show delayed healing and hypersensitivity reactions. The present study sought to correlate histopathology of thrombus aspirates with intravascular ultrasound findings in patients with very late DES ST. METHODS AND RESULTS: The study population consisted of 54 patients (28 patients with very late DES ST and 26 controls). Of 28 patients with very late DES ST, 10 patients (1020+/-283 days after implantation) with 11 ST segments (5 sirolimus-eluting stents, 5 paclitaxel-eluting stents, 1 zotarolimus-eluting stent) underwent both thrombus aspiration and intravascular ultrasound investigation. ISA was present in 73% of cases with an ISA cross-sectional area of 6.2+/-2.4 mm(2) and evidence of vessel remodeling (index, 1.6+/-0.3). Histopathological analysis showed pieces of fresh thrombus with inflammatory cell infiltrates (DES, 263+/-149 white blood cells per high-power field) and eosinophils (DES, 20+/-24 eosinophils per high-power field; sirolimus-eluting stents, 34+/-28; paclitaxel-eluting stents, 6+/-6; P for sirolimus-eluting stents versus paclitaxel-eluting stents=0.09). The mean number of eosinophils per high-power field was higher in specimens from very late DES ST (20+/-24) than in those from spontaneous acute myocardial infarction (7+/-10), early bare-metal stent ST (1+/-1), early DES ST (1+/-2), and late bare-metal stent ST (2+/-3; P from ANOVA=0.038). Eosinophil count correlated with ISA cross-sectional area, with an average increase of 5.4 eosinophils per high-power field per 1-mm(2) increase in ISA cross-sectional area. CONCLUSIONS: Very late DES thrombosis is associated with histopathological signs of inflammation and intravascular ultrasound evidence of vessel remodeling. Compared with other causes of myocardial infarction, eosinophilic infiltrates are more common in thrombi harvested from very late DES thrombosis, particularly in sirolimus-eluting stents, and correlate with the extent of stent malapposition.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology
04 Faculty of Medicine > Department of Dermatology, Urology, Rheumatology, Nephrology, Osteoporosis (DURN) > Clinic of Rheumatology, Clinical Immunology and Allergology
04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine

UniBE Contributor:

Cook, Stéphane; Vogel, Rolf; Togni, Mario; Wenaweser, Peter Martin; Billinger, Michael; Seiler, Christian; Meier, Bernhard; Pichler, Werner Joseph; Jüni, Peter and Windecker, Stephan

ISSN:

0009-7322

ISBN:

19620501

Publisher:

Lippincott Williams & Wilkins

Language:

English

Submitter:

Factscience Import

Date Deposited:

04 Oct 2013 15:09

Last Modified:

23 Jun 2015 16:00

Publisher DOI:

10.1161/CIRCULATIONAHA.109.854398

PubMed ID:

19620501

Web of Science ID:

000268638700010

Uncontrolled Keywords:

Aged, Angioplasty, Balloon, Coronary, Biological Markers, Coronary Artery Disease, Coronary Thrombosis, Coronary Vessels, Drug-Eluting Stents, Eosinophils,Female, Humans, Male, Middle Aged, Thrombectomy, Ultrasonography, Interventional, Vasculitis

BORIS DOI:

10.7892/boris.30213

URI:

https://boris.unibe.ch/id/eprint/30213 (FactScience: 191459)

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