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

作者：Inaba Shinji; Mintz Gary S; Yun Kyeong Ho; Yakushiji Tadayuki; Shimizu Takehisa; Kang Soo Jin; Genereux Philippe; Weisz Giora; Rabbani LeRoy E; Moses Jeffrey W; Stone Gregg W; Maehara Akiko^*

来源：Eurointervention, 2014, 9(11): 1301-1308.

DOI：10.4244/EIJV9I11A220

• everolimus-eluting stent
• intravascular ultrasound
• stent fracture

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. %26lt;br%26gt;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 %26gt;50% neointimal hyperplasia in 12 (92.3%). %26lt;br%26gt;Conclusions: We found EES mechanical complications, often followed by longitudinal deformation or fracture leading to excessive neointimal hyperplasia, in-stent restenosis, and repeat revascularisation.

• 出版日期2014-3