Drug eluting stent (DES) thrombosis may be triggered by different phenomenon that require specific treatment and can vary according to the device properties.

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)

Click Images to enlarge :: Cliquez sur l’image à agrandir

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.