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Novel predictors of late lumen enlargement in distal reference segments after successful recanalization of coronary chronic total occlusion Coronary plaque redistribution after stent implantation is determined by lipid composition: A NIRS-IVUS analysis Optical coherence tomography and intravascular ultrasound assessment of the anatomic size and wall thickness of a muscle bridge segment Intravascular ultrasound-guided drug-eluting stent implantation is associated with improved clinical outcomes in patients with unstable angina and complex coronary artery true bifurcation lesions Prognostic Value of Intravascular Ultrasound in Patients With Coronary Artery Disease Comparison of plaque characteristics in narrowings with ST-elevation myocardial infarction (STEMI), non-STEMI/unstable angina pectoris and stable coronary artery disease (from the ADAPT-DES IVUS Substudy) Impact of Positive and Negative Lesion Site Remodeling on Clinical Outcomes : Insights From PROSPECT Relation between baseline plaque features and subsequent coronary artery remodeling determined by optical coherence tomography and intravascular ultrasound Percutaneous Coronary Intervention for Vulnerable Coronary Atherosclerotic Plaque Assessment of coronary atherosclerosis by IVUS and IVUS-based imaging modalities: progression and regression studies, tissue composition and beyond
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Original Research2014 Mar 20;9(11):1301-8.

JOURNAL：EuroIntervention. Article Link

Mechanical complications of everolimus-eluting stents associated with adverse events: an intravascular ultrasound study

Inaba S, Mintz GS, Yun KH et al. Keywords: intravascular ultrasound; everolimus-eluting stent; stent fracture

ABSTRACT

AIMS - Mechanical complications contribute to bare metal and first-generation drug-eluting stent (DES) failure. However, the importance of the mechanical complications of second-generation DES remains unclear. We report mechanical complications associated with everolimus-eluting stent (EES) failures.


METHODS AND RESULTS - We retrospectively analysed 177 consecutive EES-treated lesions in 136 patients who underwent intravascular ultrasound (IVUS) at follow-up. Mechanical complications were identified in 17 patients (five stable angina, 10 unstable angina, two non-ST-elevation myocardial infarction [NSTEMI] without angiographic thrombus). Fifteen (88.2%) were treated with repeat revascularisation. By IVUS, there were 16 focal (94.1%) and one diffuse (5.9%) in-stent restenoses. Complete stent fracture with separation was seen in only one, partial stent fracture with separation was seen in three, and in 13 there was longitudinal deformation (n=2) or stent strut fracture (n=11) with overlapping of the proximal and distal stent fragments. In 13 EES with evidence of overlapping in the setting of either fracture or deformation, there was a 35.5±12.2% smaller stent area compared to the adjacent proximal and distal stent fragments, and >50% neointimal hyperplasia in 12 (92.3%).

CONCLUSIONS - We found EES mechanical complications, often followed by longitudinal deformation or fracture leading to excessive neointimal hyperplasia, in-stent restenosis, and repeat revascularisation.
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