Drug eluting stent (DES) thrombosis may be triggered by different phenomenon that require specific treatment and can vary according to the device properties.
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N. Amabile, CM. Tissot, C.Trouillet, X. Chabin, P. Barnay, R. Delaunay
S. Levesque, T. Lhermusier, G. Rioufol & G. Souteyrand
On behalf of the PESTO investigators
Disclosure Statement of Financial Interest
Within the past 12 months, I, NICOLAS AMABILE, or my spouse/partner have had a financial interest/arrangement or affiliation with the organization(s) listed below.
Affiliation/Financial Relationship
Consulting Fees/Honoraria
Company
St Jude Medical , Boston Scientific , Astra Zeneca
BACKGROUND
Drug eluting stent (DES) thrombosis may be triggered by different phenomenon that require specific treatment and can vary according to the device properties.
• However, angiography alone is frequently limited to correctly identify these mechanisms.
OBJECTIVES
• The present work aims to investigate and compare the mechanical abnormalities associated with DES thrombosis in 1st generation (paclitaxel -and sirolimus-eluting stents/ DES1G) and 2nd generation (everolimus- and zotaralimus-eluting stents/DES2G) devices among a large cohort of patients explored by optical coherence tomography (OCT).
METHODS (1)
• The PESTO study was a prospective national multicenter registry
involving 29 French catheterization labs.
• Patients who were referred with acute coronary syndromes
(ACS) were prospectively screened for presence of definite ST and
explored by OCT after culprit lesion deocclusion if needed.
• ST was classified as acute (AST), sub-acute (SAST), late (LST) and
very late (VLST), according to the Academic Research Consortium
(ARC) criteria.
METHODS (2)
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ST type & underlying device
N=120 patients included in the final analysis
RESULTS – 1
N=71 patients with DES thrombosis included in the final analysis
RESULTS – 2
RESULTS – 3
RESULTS – 4
RESULTS – 5
Patients presenting with LST+VLST (n=57)
RESULTS – 6
Quantitative OCT data in all patients (n=69)
RESULTS – 7
Quantitative OCT data in LST+VLST patients (n=57)
CONCLUSIONS
• In this prospective registry, DES thrombosis mainly occurred ≥ 1 year after initial procedure and involved 1st and 2nd generation DES.
• Ruptured neoatherosclerosis was more frequent in DES1g than in DES2g group, but this observation might be related to the longer delay between initial PCI and ST in paclitaxel- or sirolimus-eluting stents patients compared to the others.
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