Mechanisms of Very Late Stent Thrombosis in Japanese Patients as Assessed by Optical Coherence Tomography

Calcified nodules in the coronary arteries: systematic review on incidence and percutaneous coronary intervention outcomes

INTRODUCTION AND OBJECTIVES

Calcified nodules (CN) have been associated with higher complexity and worse outcomes after percutaneous coronary intervention (PCI) in both stable and unstable coronary disease. The aim of this systematic review was to summarize the current evidence on CN.

METHODS

Systematic review of published studies on the prevalence, clinical associations, and impact of CN on outcomes after PCI up to November 2024.

RESULTS

We identified 474 publications, of which 87 were included (all observational). CN were divided into 2 types: noneruptive CN (NECN), with an intact fibrous cap; and eruptive CN (ECN), with disruption of the fibrous cap with or without thrombus. The most common location was the right coronary artery (28%-71%). Angiography-based diagnostic sensitivity was low (18%-38%). Optical coherence tomography was preferred for type differentiation. The main clinical factors associated with CN were older age, diabetes mellitus, and chronic kidney disease. CN were considered the culprit lesion in 3% to 18% of acute coronary syndromes but were also present in up to 30% of nonculprit arteries. ECN were associated with more events at follow-up than NECN (20% vs 3.3% at 1 year). Post-PCI, CN were associated with lower minimum lumen area (MLA), higher rates of stent-edge dissection (44%-73%), malapposition (71%-96%), and underexpansion (60%-77%). ECN were associated with better acute results but worse long-term outcomes compared with NECN.

CONCLUSIONS

CN are often present in acute coronary syndrome culprit and stable coronary lesions. Intracoronary imaging is essential for the diagnosis and differentiation of CN. CN are associated with worse outcomes after PCI, acutely and during follow-up.

Silent In-Stent Thrombosis Diagnosed by Optical Coherence Tomography and Histopathology of Directional Coronary Atherectomy Specimen

A 75-year-old woman who underwent percutaneous coronary intervention using an everolimus-eluting stent showed silent in-stent occlusion. Pathological examination of the neointima, resected through directional coronary atherectomy, revealed a double-layered neointima with neointimal hyperplasia and thrombus. Stent-edge restenosis and subsequent thrombosis, related to clopidogrel resistance, likely caused the in-stent thrombotic occlusion.

"Very" Very Late Stent Thrombosis: The Occurrence of Thrombosis 12.3 Years After Paclitaxel-Eluting Stent Implantation

Very late stent thrombosis (VLST) refers to stent thrombosis occurring beyond one year after coronary intervention. "Very" very or extremely late stent thrombosis (VVLST), occurring after five years of drug-eluting stent (DES) implantation, is extremely rare. We report a case of a 60-year-old male patient with ST-elevation myocardial infarction (STEMI) due to in-stent thrombosis 12.3 years after first-generation DES implantation; we also engage in a brief discussion of its pathogenesis and prevention.