Korean Circ J.  2020 Oct;50(10):880-889. 10.4070/kcj.2020.0198.

Long-term Clinical Outcomes of DrugEluting Stent Malapposition

• Lee SY
• Mintz GS
• Kim JS
• Kim BK
• Jang Y
• Hong MK

• KMID: 2507005
• DOI: http://doi.org/10.4070/kcj.2020.0198

Abstract

Previous pathologic, intravascular imaging, and clinical studies have investigated the association between adverse cardiac events and stent malapposition, including acute stent malapposition (ASM, that is detected at index procedure) and late stent malapposition (LSM, that is detected during follow-up) that can be further classified into late-persistent stent malapposition (LPSM, ASM that remains at follow-up) or late-acquired stent malapposition (LASM, newly developed stent malapposition at follow-up that was not present immediately after index stent implantation). ASM has not been associated with adverse cardiac events compared with non-ASM, even in lesions with large-sized malapposition. The clinical outcomes of LSM may depend on its subtype. The recent intravascular ultrasound studies with long-term follow-up have consistently demonstrated that LASM steadily increased the risk of thrombotic events in patients with first-generation drug-eluting stents (DESs). This association has not yet been identified in LPSM. Accordingly, it is reasonable that approaches to stent malapposition should be based on its relationship with clinical outcomes. ASM may be tolerable after successful stent implantation, whereas prolonged anti-thrombotic medications and/or percutaneous interventions to modify LASM may be considered in selected patients with first-generation DESs. However, these treatments are still questionable due to lack of firm evidences.

Keyword

Coronary artery disease; Percutaneous coronary intervention; Stents

Figure

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  Figure 1 Resolution of acute stent malapposition assessed by optical coherence tomography. The malapposed strut (arrow) at index procedure (left) was resolved at 1 year of follow-up (right) through neointimal integration between stent strut and vessel wall.

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  Figure 2 Overview of stent malapposition assessed by intravascular imaging modality. Even though malapposed struts immediately after stent implantation remain occasionally during follow-up, they usually do not link to ST. However, LASM increases the risk of ST through chronic inflammatory reactions especially in first-generation DESs.DES = drug-eluting stent; LASM = late-acquired stent malapposition; ST = stent thrombosis.

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