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Long-term Clinical Outcomes of Drug-Eluting Stent Malapposition

Korean Circulation Journal 2020년 50권 10호 p.880 ~ 889
이승률, Mintz Gary S., 김정선, 김병극, 장양수, 홍명기,
소속 상세정보
이승률 ( Lee Seung-Yul ) - Wonkwang University Hospital Regional Cardiocerebrovascular Center
 ( Mintz Gary S. ) - Cardiovascular Research Foundation
김정선 ( Kim Jung-Sun ) - Yonsei University Health System Severance Cardiovascular Hospital Division of Cardiology
김병극 ( Kim Byeong-Keuk ) - Yonsei University Health System Severance Cardiovascular Hospital Division of Cardiology
장양수 ( Jang Yang-Soo ) - Yonsei University Health System Severance Cardiovascular Hospital Division of Cardiology
홍명기 ( Hong Myeong-Ki ) - Yonsei University Health System Severance Cardiovascular Hospital Division of Cardiology

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.

키워드

Coronary artery disease; Percutaneous coronary intervention; Stents

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