Mechanical complications of everolimus-eluting stents associated with adverse events

An intravascular ultrasound study

Shinji Inaba, Gary S. Mintz, Kyeong Ho Yun, Tadayuki Yakushiji, Takehisa Shimizu, Soo Jin Kang, Philippe Genereux, Giora Weisz, Le Roy E. Rabbani, Jeffrey W. Moses, Gregg W. Stone, Akiko Maehara

Research output: Contribution to journalArticle

13 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)1301-1308
Number of pages8
JournalEuroIntervention
Volume9
Issue number11
DOIs
StatePublished - Jan 1 2014
Externally publishedYes

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Stents
Drug-Eluting Stents
Hyperplasia
Everolimus
Stable Angina
Unstable Angina
Thrombosis
Metals

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Inaba, S., Mintz, G. S., Yun, K. H., Yakushiji, T., Shimizu, T., Kang, S. J., ... Maehara, A. (2014). Mechanical complications of everolimus-eluting stents associated with adverse events: An intravascular ultrasound study. EuroIntervention, 9(11), 1301-1308. https://doi.org/10.4244/EIJV9I11A220
Inaba, Shinji ; Mintz, Gary S. ; Yun, Kyeong Ho ; Yakushiji, Tadayuki ; Shimizu, Takehisa ; Kang, Soo Jin ; Genereux, Philippe ; Weisz, Giora ; Rabbani, Le Roy E. ; Moses, Jeffrey W. ; Stone, Gregg W. ; Maehara, Akiko. / Mechanical complications of everolimus-eluting stents associated with adverse events : An intravascular ultrasound study. In: EuroIntervention. 2014 ; Vol. 9, No. 11. pp. 1301-1308.
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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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Inaba, S, Mintz, GS, Yun, KH, Yakushiji, T, Shimizu, T, Kang, SJ, Genereux, P, Weisz, G, Rabbani, LRE, Moses, JW, Stone, GW & Maehara, A 2014, 'Mechanical complications of everolimus-eluting stents associated with adverse events: An intravascular ultrasound study', EuroIntervention, vol. 9, no. 11, pp. 1301-1308. https://doi.org/10.4244/EIJV9I11A220

Mechanical complications of everolimus-eluting stents associated with adverse events : An intravascular ultrasound study. / Inaba, Shinji; Mintz, Gary S.; Yun, Kyeong Ho; Yakushiji, Tadayuki; Shimizu, Takehisa; Kang, Soo Jin; Genereux, Philippe; Weisz, Giora; Rabbani, Le Roy E.; Moses, Jeffrey W.; Stone, Gregg W.; Maehara, Akiko.

In: EuroIntervention, Vol. 9, No. 11, 01.01.2014, p. 1301-1308.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Mechanical complications of everolimus-eluting stents associated with adverse events

T2 - An intravascular ultrasound study

AU - Inaba, Shinji

AU - Mintz, Gary S.

AU - Yun, Kyeong Ho

AU - Yakushiji, Tadayuki

AU - Shimizu, Takehisa

AU - Kang, Soo Jin

AU - Genereux, Philippe

AU - Weisz, Giora

AU - Rabbani, Le Roy E.

AU - Moses, Jeffrey W.

AU - Stone, Gregg W.

AU - Maehara, Akiko

PY - 2014/1/1

Y1 - 2014/1/1

N2 - 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.

AB - 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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