Author + information
- Hiroyoshi Mori,
- Robert Kutys,
- Sho Torii,
- Emanuel Harari,
- Maria Romero,
- Renu Virmani and
- Aloke Finn
Background: Left main stenting using drug eluting stents is considered a acceptable treatment in patients with isolated left main disease or those at high risk for surgery. Stent thrombosis (ST) is a known and catastrophic complication associated with left main stenting yet the pathologic risk factors for ST have never been systematically studied.
Methods: From our autopsy stent registry (1048 lesions, 614 cases), 39 stents (BMS, n=9; 1st generation DES, n=17; and 2nd generation, n=11 DES) had been implanted in the left main artery. Stented coronary arteries were radiographed, dissected from heart, embedded in plastic, segmented at 3 mm intervals, sectioned at 4-6 microns and stained with H&E and Movat pentachrome. Mechanisms of stent failure were assessed pathologically.
Results: Eight stents implants were isolated to the left main while the majority of stent involved left main bifurcation lesions using provisional single stent (n=9) or multiple stent (n=22) techniques (Table1). Stent failures were observed in 17 lesions (14 thrombosis, 3 restenosis, Table 2). Early stent thrombosis was observed in 7(50%); late in 2 (14%), and very late thrombosis in 5 (36%). The most frequent cause of thrombosis (Table 3) was stent malapposition, n=7 (50%); whereas uncovered strut (14%), multiple stents technique (14%) and provisional stent technique without side branch dilatation (14%) were less frequently observed.
Conclusions: The most frequent cause of stent thrombosis for left main stenting was malapposition.
Poster Hall, Hall C
Friday, March 17, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Complex Coronary Intervention: Left Main/Bifurcations and Multivessel Disease
Abstract Category: 22. Interventional Cardiology: Coronary Intervention: Left Main, Multivessel, Bifurcation
Presentation Number: 1157-192
- 2017 American College of Cardiology Foundation