Serial intravascular ultrasound assessment of very late stent thrombosis after sirolimus-eluting stent placement

Positive Vessel Remodelling

Since its introduction, the success of percutaneous transluminal coronary angioplasty (PTCA) has been jeopardised by recoil, neointima proliferation, and luminal renarrowing; however, the benefit of positive remodelling has not gained widespread attention. While vessels will remodel positively up to a certain stage in the development of atherosclerosis, the therapeutic application of this process remains low. The prevention of vessel shrinkage during the healing process, which represents the predominant mechanism of restenosis after PTCA, is a prerequisite of long-term success in PTCA. The antiproliferative drugs that are currently used mainly on stents are known to be capable of this. Primary clinical studies have reported that positive remodelling leads to beneficial effects in coronary and peripheral angioplasty if no foreign body is inserted, and a paradigm change in percutaneous coronary intervention towards far fewer implants is within reach.

Relation between stent thrombosis and calcium channel blocker after drug-eluting stent implantation: Kumamoto Intervention Conference Study (KICS) registry

BACKGROUND

Stent thrombosis (ST) has emerged as a severe complication of percutaneous coronary intervention (PCI). Since the occurrence of ST is lower in Japan than Western countries, there are few data to predict ST after drug-eluting stent (DES) implantation in Japan. We examined the independent predictors of ST incidence after DES implantation in Japanese patients, including the use of calcium channel blockers (CCBs).

METHODS AND RESULTS

We used data from the Kumamoto Intervention Conference Study registry. There were 6286 consecutive patients enrolled from June 2008 to March 2011. Among them, we analyzed 3493 patients who underwent DES implantation. The incidence of definite/probable ST throughout a median follow-up period of 364 days was 0.57% (20 patients). There were 8 patients with early ST (within 30 days), 8 patients with late ST (between 31 and 365 days), and 4 patients with very late ST (after 1 year). The frequency of CCB use was significantly lower in ST than non-ST patients (25.0% versus 51.4%, respectively, p=0.016). Multiple regression analysis showed that longer stent length (p=0.034), acute coronary syndrome (p=0.039), and the absence of CCB use (p=0.046) were significant and independent predictors of ST within 1 year.

CONCLUSIONS

These results suggest that CCB use may be associated with a decreased risk of ST after DES implantation within 1 year in Japanese patients.