Southwest Hospital

Southwest Hospital冠 状 动 脉 支 架 内 血 栓 —— 早 期 、 晚 期 、 极 晚 期Intracoronary Stent Thrombosis: Early,Late and Very Late何 国 祥第 三 军 医 大 学 西 南 医 院重 庆 市 介 入 心 脏 病 学 研 究 所Porf. HE Guo-xiangDept. of Cardiology, Southwest HospitalThe Thrid Military Medical UniversityChongqing Institute of Interventional Cardiology

Intracoronary Stent Thrombosis:Early,Late,and Very LateSouthwest Hospital

Intracoronary Stent Thrombosis:Early,Late,and Very LateTable 2. Incidence of Stent Thrombosis andPatients at Risk Over TimeFollow-Up Time 1 Year 2 Years 3 YearsDES Thrombosis,CumulativeIncidence 1.2% 1.6% 2.0%Patients at Risk 17,040 11,180 4,110Southwest Hospital

冠 状 动 脉 支 架 内 血 栓 —— 早 期 、 晚 期 、 极 晚 期Data from the largest registry to dateaddressing the issue of late thrombosis withdrug-eluting stents (DES) showed a slight,0.4% per year increase in risk in over 23,000patients out to 3 years.First presented at TCT 2007, results from the ESTROFA (Estudio ESpañolsobre TROmbosis de stents FArmacoactivos) registry appear in the March11, 2008, issue of the Journal of the American College of Cardiology.Southwest Hospital

Intracoronary Stent Thrombosis:Early,Late,and Very LateFigure 2. Occurrence and frequency of stent thrombosisover timeBetween April, 2002, and Dec, 2005, 8146 patients underwentpercutaneous coronary intervention with sirolimus-eluting stents (SES;n=3823) or paclitaxel-eluting stents (PES; n=4323) at two academichospitals.Southwest Hospital

Intracoronary Stent Thrombosis:Early,Late,and Very LateSouthwest Hospital

Intracoronary Stent Thrombosis:Early,Late,and Very LateTable 1. Stent Thrombosis Rates in theESTROFA Registry (n=301)DES “real-world”N=23000, FU 3 years; from 2002 to 2007 ; at 20 centersacross Spainstent thrombosis =301 patients (1.28%)Southwest Hospital

Intracoronary Stent Thrombosis:Early,Late,and Very LateSouthwest Hospital

Intracoronary Stent Thrombosis:Early,Late,and Very LateSouthwest Hospital

冠 状 动 脉 支 架 内 血 栓 —— 早 期 、 晚 期 、 极 晚 期BMS: late stent thrombosis: 0.6% to 0.8%Southwest Hospital

Intracoronary Stent Thrombosis:Early,Late,and Very LateSouthwest Hospital

冠 状 动 脉 支 架 内 血 栓 —— 早 期 、 晚 期 、 极 晚 期相 关 因 素 :STEMI (HR 5.2, 95% CI 5.5-7.6, P

冠 状 动 脉 支 架 内 血 栓 —— 早 期 、 晚 期 、 极 晚 期Southwest Hospital

Intracoronary Stent Thrombosis:Early,Late,and Very LateSouthwest Hospital

冠 状 动 脉 支 架 内 血 栓 —— 早 期 、 晚 期 、 极 晚 期Southwest Hospital

冠 状 动 脉 支 架 内 血 栓 —— 早 期 、 晚 期 、 极 晚 期Southwest Hospital

Intracoronary Stent Thrombosis:Early,Late,and Very LateSouthwest Hospital

Intracoronary Stent Thrombosis:Early,Late,and Very LateSouthwest Hospital

Intracoronary Stent Thrombosis:Early,Late,and Very LateSouthwest Hospital

冠 状 动 脉 支 架 内 血 栓 —— 早 期 、 晚 期 、 极 晚 期Southwest Hospital

冠 状 动 脉 支 架 内 血 栓 —— 早 期 、 晚 期 、 极 晚 期Southwest Hospital

冠 状 动 脉 支 架 内 血 栓 —— 早 期 、 晚 期 、 极 晚 期Southwest Hospital

冠 状 动 脉 支 架 内 血 栓 —— 早 期 、 晚 期 、 极 晚 期Southwest Hospital

Intracoronary Stent Thrombosis:Early,Late,and Very LateSouthwest Hospital

Intracoronary Stent Thrombosis:Early,Late,and Very LateSouthwest Hospital

Intracoronary Stent Thrombosis:Early,Late,and Very LateFig. 1. (A) Occlusion of the right coronary artery. (B) Balloon angioplastyrevealed a huge organized thrombus and an intermediate stenosis of the midright coronary artery. (C) Result after stent implantation to the mid rightcoronary artery. (D) Recurrent occlusion of the right coronary artery by thethrombus.Southwest Hospital

冠 状 动 脉 支 架 内 血 栓 —— 早 期 、 晚 期 、 极 晚 期ST 的 检 出 和 评 价 方 法Southwest Hospital

Intracoronary Stent Thrombosis:Early,Late,and Very LateSouthwest Hospital

冠 状 动 脉 支 架 内 血 栓 —— 早 期 、 晚 期 、 极 晚 期Southwest Hospital

Intracoronary Stent Thrombosis:Early,Late,and Very LateSouthwest Hospital

Intracoronary Stent Thrombosis:Early,Late,and Very LateSouthwest Hospital

Intracoronary Stent Thrombosis:Early,Late,and Very LateSouthwest Hospital

Intracoronary Stent Thrombosis:Early,Late,and Very LateSouthwest Hospital

Intracoronary Stent Thrombosis:Early,Late,and Very LateSouthwest Hospital

冠 状 动 脉 支 架 内 血 栓 —— 早 期 、 晚 期 、 极 晚 期Southwest Hospital

冠 状 动 脉 支 架 内 血 栓 —— 早 期 、 晚 期 、 极 晚 期1-year mortality :acute or subacute thrombosis : 19%late/very late thrombosis: 13%Southwest Hospital

冠 状 动 脉 支 架 内 血 栓 —— 早 期 、 晚 期 、 极 晚 期Southwest Hospital

Intracoronary Stent Thrombosis:Early,Late,and Very LateSouthwest Hospital

Intracoronary Stent Thrombosis:Early,Late,and Very LateFigure 7. Impact of Thrombus Burden and IRA-ST on MACETwo-year cumulative major adverse cardiacevent (MACE) rate (A), post-30-dayscumulative MACE rate (B), and post-30-dayscumulative MACE rate after excludingpatients with infarct-related artery stentthrombosis (C) in relation to large thrombusburden (LTB) and small thrombus burden(STB) at the index procedureSouthwest Hospital

Intracoronary Stent Thrombosis:Early,Late,and Very LateSouthwest Hospital

冠 状 动 脉 支 架 内 血 栓 —— 早 期 、 晚 期 、 极 晚 期Southwest Hospital

冠 状 动 脉 支 架 内 血 栓 —— 早 期 、 晚 期 、 极 晚 期Southwest Hospital

冠 状 动 脉 支 架 内 血 栓 —— 早 期 、 晚 期 、 极 晚 期Southwest Hospital

冠 状 动 脉 支 架 内 血 栓 —— 早 期 、 晚 期 、 极 晚 期Southwest Hospital

冠 状 动 脉 支 架 内 血 栓 —— 早 期 、 晚 期 、 极 晚 期Southwest Hospital

Intracoronary Stent Thrombosis:Early,Late,and Very LateSouthwest Hospital

Intracoronary Stent Thrombosis:Early,Late,and Very LateSouthwest Hospital

Intracoronary Stent Thrombosis:Early,Late,and Very LateSouthwest Hospital

Intracoronary Stent Thrombosis:Early,Late,and Very LateSouthwest Hospital

Intracoronary Stent Thrombosis:Early,Late,and Very LateSouthwest Hospital

Intracoronary Stent Thrombosis:Early,Late,and Very LateSouthwest Hospital

Intracoronary Stent Thrombosis:Early,Late,and Very LateSouthwest Hospital

Intracoronary Stent Thrombosis:Early,Late,and Very LateSouthwest Hospital

Intracoronary Stent Thrombosis:Early,Late,and Very LateSouthwest Hospital

Intracoronary Stent Thrombosis:Early,Late,and Very LateFig. 3. Gross pathology of interior of PTFE( 聚 四 氟 乙 烯 )-covered stent after 40 days of implantation in the abdominalaorta (A) and IVC (B). Note the uniform layer of neointimacoating the inside of the stent and the absence of thrombusformation in the aorta as compared to the vein that has moreirregular intimal proliferation and fibrin deposition (bar=2 cm).Southwest Hospital

Intracoronary Stent Thrombosis:Early,Late,and Very LateFig. 4. Site of stentin aorta (A and C)and IVC (B and D).Note the markeddifference inneointimal thickness(broken lines) inthe aorta (A)compared to the IVC(B). In both vesselsthe neointima iscovered by a layerof endothelial-likecells (E) with nofibrin deposition.Asterisks indicatethe sites from whichthe stent strutshave been removed,with PTFE, blackmaterial, remaining(all H&E, originalmagnification: A andB, ×40; C and D,×100).PTFE=polytetrafluoroethylene.Southwest Hospital

Intracoronary Stent Thrombosis:Early,Late,and Very LateFig. 5. Histopathology of PTFE-covered stent in abdominal aorta (A) and IVC (B). (A) Note bifrigence of PTFEexposed to polarized light (original magnification: ×100). (B) PTFE material (arrow) has a refractileappearance in histologic sections. Note the ingrowth of connective tissue into and around the PTFE layer inboth views (H&E stain, original magnification: ×100). PTFE=polytetrafluoroethylene( 聚 四 氟 乙 烯 ).Southwest Hospital

Intracoronary Stent Thrombosis:Early,Late,and Very LateSouthwest Hospital

Intracoronary Stent Thrombosis:Early,Late,and Very LateSouthwest Hospital

Intracoronary Stent Thrombosis:Early,Late,and Very LateSouthwest Hospital

Intracoronary Stent Thrombosis:Early,Late,and Very LateSouthwest Hospital

Intracoronary Stent Thrombosis:Early,Late,and Very LateSouthwest Hospital

Intracoronary Stent Thrombosis:Early,Late,and Very LateThank you!