BACKGROUND: -The pathomechanisms underlying very late stent @entity715 (VLST) after implantation of drug-eluting stents (DES) are incompletely understood. Using optical coherence tomography (OCT), we investigated potential causes of this adverse event. METHODS AND RESULTS: -Between August 2010 and December 2014, 64 @entity1 were investigated at the time-point of VLST as part of an international OCT registry. OCT pullbacks were performed after restoration of flow and analyzed at 0.4mm. A total of 38 early- and 20 newer-generation DES were suitable for analysis. VLST occurred at a median time of 4.7 years (IQR 3.1 to 7.5). An underlying putative cause by OCT was identified in 98% of cases. The most frequent finding was strut malapposition (34.5%), neoatherosclerosis (27.6%), uncovered struts (12.1%), and stent underexpansion (6.9%). Uncovered and malapposed struts were more frequent in thrombosed compared with non-thrombosed regions (ratio of percentages 9.27, 95% CI 4.71 to 17.85, p<0.001 and 7.55, 95% CI 3.34 to 15.09, p<0.001, respectively). The maximal length of malapposed or uncovered struts (3.40mm, 95% CI 2.55 to 4.25 versus 1.29mm, 95% CI 0.81 to 1.77, p<0.001) but not the maximal or average axial malapposition distance was greater in thrombosed compared with non-thrombosed segments. The association of both uncovered and malapposed struts with @entity715 were consistent among early- and newer-generation DES. CONCLUSIONS: -The leading associated findings in VLST @entity1 in descending order were malapposition, neoatherosclerosis, uncovered struts and stent underexpansion without difference between early- and new- generation DES treated @entity1 . The longitudinal extension of malapposed and uncovered stent was the most important correlate of @entity715 formation in VLST.

Mechanisms of Very Late Drug-Eluting Stent XXXX Assessed by Optical Coherence Tomography.

@entity1 :: ('9606', 'Species') :: ['patients'] @entity715 :: ('MESH:D013927', 'Disease') :: ['thrombosis', 'thrombus']
@entity715 :: (MESH:D013927,Disease) :: ['Thrombosis']
