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Neoatherosclerosis, plaque rupture and very late stent thrombosis of a first generation drug eluting stent treated with aspiration thrombectomy and newer generation drug eluting stent implantation
Neoatherosclerosis, plaque rupture and very late stent thrombosis of a first generation drug eluting stent treated with aspiration thrombectomy and newer generation drug eluting stent implantation Ahmad Mustafa, Safa Daghem, Vasim Farooq, Farzin Fath-Ordoubadi, Bernard Clarke PII: DOI: Reference:
S0167-5273(14)02542-X doi: 10.1016/j.ijcard.2014.12.118 IJCA 19501
To appear in:
International Journal of Cardiology
Received date: Accepted date:
8 December 2014 28 December 2014
Please cite this article as: Mustafa Ahmad, Daghem Safa, Farooq Vasim, Fath-Ordoubadi Farzin, Clarke Bernard, Neoatherosclerosis, plaque rupture and very late stent thrombosis of a first generation drug eluting stent treated with aspiration thrombectomy and newer generation drug eluting stent implantation, International Journal of Cardiology (2014), doi: 10.1016/j.ijcard.2014.12.118
This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT Neoatherosclerosis, plaque rupture and very late stent thrombosis of a first generation drug eluting stent treated with aspiration
PT
thrombectomy and newer generation drug eluting stent implantation
SC RI
Ahmad Mustafa MB BCh FRACP, Safa Daghem MBChB, MRCP; Vasim Farooq MBChB, MRCP, PhD; Farzin Fath-Ordoubadi Bsc MB BCHIR, MD, FRCP; Bernard
NU
Clarke BSc, MBChB, MD, FRCP, FESC, FACC
Manchester Heart Centre, Manchester Royal Infirmary, Central Manchester
MA
University Hospitals NHS Trust, Manchester, United Kingdom
ED
Institute of Cardiovascular Sciences, Manchester Academic Health Sciences
PT
Centre, University of Manchester
Conflicts of Interest: The authors report no conflicts of interest.
CE
Word Count: 297
AC
References: 2
Corresponding Author: Dr Vasim Farooq
*Address for correspondence: Manchester Heart Centre, Manchester Royal Infirmary Central Manchester University Hospitals NHS Trust Manchester, United Kingdom Email: [email protected]
ACCEPTED MANUSCRIPT A 53-year-old male presented with an anterior ST-elevation myocardial infarction (STEMI). Coronary angiography (upper-left-panel) demonstrated very late stent
PT
thrombosis with Thrombolysis In Myocardial Infarction (TIMI) 1 flow in the mid left anterior descending (LAD). Seven years previously the patient had undergone
SC RI
implantation of a first-generation paclitaxel-eluting stent (TAXUS Liberte, Boston Scientific) to the mid LAD.
NU
Manual thrombectomy (Export aspiration catheter, Medtronic CardioVascular) aspirated an organised red thrombus mass (inset, upper-middle-panel) with restoration
MA
of TIMI III flow to the LAD (upper-middle-panel). Optical coherence tomography (C7 Dragonfly™, LightLab Imaging) (lower-panels) demonstrated severe in-stent
ED
restenosis, advanced neoatherosclerosis with necrotic core and a focal area of fibrous cap rupture (asterisk, lower-middle-panel). Due to atherosclerotic disease extending
PT
beyond the proximal stent margin, a 3.5x33mm everolimus-eluting stent (XIENCE,
CE
Abbott Vascular) was implanted and proximally optimised with a 4mm non-
AC
compliant balloon (Hiryu, Terumo) (upper-right-panel). In-stent neoatherosclerosis has been shown to be an important mechanism of late drug-eluting stent (DES) failure with first and newer generation DES. (1) Despite the negative impact of manual thrombectomy on mortality at 1-year following STEMI in the multicenter, randomized registry TASTE (Thrombus Aspiration in ST-Elevation Myocardial Infarction in Scandinavia) trial, (2) uncertainty remains regarding the role of manual thrombectomy in STEMI for important clinical outcomes in all subsets of patients.
ACCEPTED MANUSCRIPT Figure 1: Mechanism of very late stent thrombosis. Coronary angiography and optical coherence tomography demonstrating plaque rupture of in-stent
PT
restenosis and neoatherosclerosis associated with a first generation TAXUS
AC
CE
PT
ED
MA
NU
SC RI
drug-eluting stent.
Asterisks indicate area of plaque rupture. Abbreviation: MLA minimal luminal area.
ACCEPTED MANUSCRIPT REFERENCES
PT
SC RI NU MA ED PT CE
2.
Otsuka F, Vorpahl M, Nakano M et al. Pathology of second-generation everolimus-eluting stents versus first-generation sirolimus- and paclitaxel-eluting stents in humans. Circulation 2014;129:211-23. Lagerqvist B, Frobert O, Olivecrona GK et al. Outcomes 1 year after thrombus aspiration for myocardial infarction. N Engl J Med 2014;371:1111-20.
AC
1.
S0167-5273(14)02542-X doi: 10.1016/j.ijcard.2014.12.118 IJCA 19501
To appear in:
International Journal of Cardiology
Received date: Accepted date:
8 December 2014 28 December 2014
Please cite this article as: Mustafa Ahmad, Daghem Safa, Farooq Vasim, Fath-Ordoubadi Farzin, Clarke Bernard, Neoatherosclerosis, plaque rupture and very late stent thrombosis of a first generation drug eluting stent treated with aspiration thrombectomy and newer generation drug eluting stent implantation, International Journal of Cardiology (2014), doi: 10.1016/j.ijcard.2014.12.118
This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT Neoatherosclerosis, plaque rupture and very late stent thrombosis of a first generation drug eluting stent treated with aspiration
PT
thrombectomy and newer generation drug eluting stent implantation
SC RI
Ahmad Mustafa MB BCh FRACP, Safa Daghem MBChB, MRCP; Vasim Farooq MBChB, MRCP, PhD; Farzin Fath-Ordoubadi Bsc MB BCHIR, MD, FRCP; Bernard
NU
Clarke BSc, MBChB, MD, FRCP, FESC, FACC
Manchester Heart Centre, Manchester Royal Infirmary, Central Manchester
MA
University Hospitals NHS Trust, Manchester, United Kingdom
ED
Institute of Cardiovascular Sciences, Manchester Academic Health Sciences
PT
Centre, University of Manchester
Conflicts of Interest: The authors report no conflicts of interest.
CE
Word Count: 297
AC
References: 2
Corresponding Author: Dr Vasim Farooq
*Address for correspondence: Manchester Heart Centre, Manchester Royal Infirmary Central Manchester University Hospitals NHS Trust Manchester, United Kingdom Email: [email protected]
ACCEPTED MANUSCRIPT A 53-year-old male presented with an anterior ST-elevation myocardial infarction (STEMI). Coronary angiography (upper-left-panel) demonstrated very late stent
PT
thrombosis with Thrombolysis In Myocardial Infarction (TIMI) 1 flow in the mid left anterior descending (LAD). Seven years previously the patient had undergone
SC RI
implantation of a first-generation paclitaxel-eluting stent (TAXUS Liberte, Boston Scientific) to the mid LAD.
NU
Manual thrombectomy (Export aspiration catheter, Medtronic CardioVascular) aspirated an organised red thrombus mass (inset, upper-middle-panel) with restoration
MA
of TIMI III flow to the LAD (upper-middle-panel). Optical coherence tomography (C7 Dragonfly™, LightLab Imaging) (lower-panels) demonstrated severe in-stent
ED
restenosis, advanced neoatherosclerosis with necrotic core and a focal area of fibrous cap rupture (asterisk, lower-middle-panel). Due to atherosclerotic disease extending
PT
beyond the proximal stent margin, a 3.5x33mm everolimus-eluting stent (XIENCE,
CE
Abbott Vascular) was implanted and proximally optimised with a 4mm non-
AC
compliant balloon (Hiryu, Terumo) (upper-right-panel). In-stent neoatherosclerosis has been shown to be an important mechanism of late drug-eluting stent (DES) failure with first and newer generation DES. (1) Despite the negative impact of manual thrombectomy on mortality at 1-year following STEMI in the multicenter, randomized registry TASTE (Thrombus Aspiration in ST-Elevation Myocardial Infarction in Scandinavia) trial, (2) uncertainty remains regarding the role of manual thrombectomy in STEMI for important clinical outcomes in all subsets of patients.
ACCEPTED MANUSCRIPT Figure 1: Mechanism of very late stent thrombosis. Coronary angiography and optical coherence tomography demonstrating plaque rupture of in-stent
PT
restenosis and neoatherosclerosis associated with a first generation TAXUS
AC
CE
PT
ED
MA
NU
SC RI
drug-eluting stent.
Asterisks indicate area of plaque rupture. Abbreviation: MLA minimal luminal area.
ACCEPTED MANUSCRIPT REFERENCES
PT
SC RI NU MA ED PT CE
2.
Otsuka F, Vorpahl M, Nakano M et al. Pathology of second-generation everolimus-eluting stents versus first-generation sirolimus- and paclitaxel-eluting stents in humans. Circulation 2014;129:211-23. Lagerqvist B, Frobert O, Olivecrona GK et al. Outcomes 1 year after thrombus aspiration for myocardial infarction. N Engl J Med 2014;371:1111-20.
AC
1.