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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EStudies have shown that drug-eluting stents (DES) are associated with delayed arterial healing and are prone to thrombosis. This article discusses the utility of intravascular ultrasound to determine mechanisms of late and very late stent thrombosis after DES implantation.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EInterventional Techniques \u0026amp; Devices\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EThrombotic Disorders\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EStudies have shown that drug-eluting stents (DES) are associated with delayed arterial healing and are prone to thrombosis. Fausto J. Pinto, MD, PhD, Lisbon University, Lisbon, Portugal, discussed the utility of intravascular ultrasound (IVUS) to determine mechanisms of late and very late stent thrombosis (ST) after DES implantation.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EArmstrong et al. [\u003Cem\u003EJACC Cardiovasc Interv\u003C\/em\u003E 2012] evaluated 7079 patients with angiographically documented early (\u0026lt;1 month), late (1 to 12 months), and very late (\u226512 months) ST. In-hospital mortality was highest in patients with early ST compared with those who had late or very late ST. Claessen et al. [\u003Cem\u003EJACC Cardiovasc Interv\u003C\/em\u003E 2011] found that IVUS-guided versus angiography-guided DES implantation appeared to be associated with a reduction in early and long-term cardiovascular events (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E).\u003C\/p\u003E\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/3\/10\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Clinical Outcomes to 2-Year Follow-Up in the Propensity-Matched Cohort.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-462763395\u0022 data-figure-caption=\u0022Clinical Outcomes to 2-Year Follow-Up in the Propensity-Matched Cohort.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/3\/10\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/3\/10\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/3\/10\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/13978\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-4\u0022 class=\u0022first-child\u0022\u003EClinical Outcomes to 2-Year Follow-Up in the Propensity-Matched Cohort.\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003EIVUS=intravascular ultrasound; TVR=target vessel revascularization.\u003C\/q\u003E\u003Cq class=\u0022attrib\u0022 id=\u0022attrib-2\u0022\u003EReproduced with permission from Elsevier. Claessen B et al. Impact of Intravascular Ultrasound Imaging on Early and Late Clinical Outcomes Following Percutaneous Coronary Intervention With Drug-Eluting Stents. \u003Cem\u003EJACC Intervention\u003C\/em\u003E 2011;4(9):974.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EMechanisms of ST\u003C\/h2\u003E\n         \u003Cp id=\u0022p-5\u0022\u003EMechanisms of ST include edge dissections, stent underexpansion, incomplete stent apposition (ISA), incomplete lesion coverage, geographic miss, tissue protrusion, and residual thrombus. IVUS-guided percutaneous coronary intervention with DES is probably most useful for restenosis, edge dissections, ST, stent underexpansion, and ISA. A recent study [Kang SJ et al. \u003Cem\u003ECirc Cardiovasc Interv\u003C\/em\u003E 2011] using IVUS to study in-stent restenosis after DES found that the primary mechanism was intimal hyperplasia and that underexpansion associated with longer stent length was an important preventable mechanism of ST. Studies have shown that the incidence of persistent edge dissections by IVUS after DES implantation is approximately 10%, of which almost 40% are not detectable by angiography.\u003C\/p\u003E\n         \u003Cp id=\u0022p-6\u0022\u003EData analysis from multiple large trials shows that potential mechanisms of ST after DES implantation include delayed healing (failure of new neointimal formation and smooth muscle cell replication, poor endothelialization) and clopidogrel-related issues (premature discontinuation, inadequate platelet inhibition). In a Kaplan-Meier analysis, Roy et al. [\u003Cem\u003EEur Heart J\u003C\/em\u003E 2008] demonstrated significantly longer ST-free survival in patients with IVUS-guided stents versus no IVUS (p=0.013). A HORIZONS substudy [Choi SY et al. \u003Cem\u003ECirc Cardiovasc Interv\u003C\/em\u003E 2011] reported that minimum lumen cross-sectional area (CSA), significant tissue protrusion, significant stent edge dissection, and significant residual stenosis but not acute malapposition were associated with early ST. However, Cook et al. [\u003Cem\u003EEur Heart J\u003C\/em\u003E 2012] found that the presence of CSA, assessed by IVUS 8 months after DES implantation, was associated with a higher rate of MI and very late ST during long-term follow-up.\u003C\/p\u003E\n         \u003Cp id=\u0022p-7\u0022\u003EThe underlying mechanisms of late ST after DES implantation include abnormal or delayed healing, inadequate endothelial cell coverage on struts, and positive remodeling consistent with underlying vascular toxicity. IVUS may help us understand the mechanisms of late ST and reduce the incidence of ST.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2012 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/12\/3\/10.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nznea1\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nznea1\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}