CLINICAL RESEARCH CORONARY INTERVENTIONS EuroIntervention 2016;12: e 1355- e 1365 published online ahead of print December 2015 published online e -edition December 2016 DOI: 10.4244/EIJY15M12_08 e 1355 © Europa Digital & Publishing 2016. All rights reserved. *Corresponding author: Department of Interventional Cardiology, Hospital Universitari de Bellvitge, c/ Feixa Llarga sn, 08907 L’Hospitalet de Llobregat, Spain. E-mail: gomezjosep@hotmail.com IVUS-guided treatment strategies for definite late and very late stent thrombosis Josep Gomez-Lara 1 *, MD, PhD; Neus Salvatella 2 , MD; Nieves Gonzalo 3 , MD, PhD; Felipe Hernández-Hernández 4 , MD; Eduard Fernandez-Nofrerias 5 , MD; Angel Sánchez-Recalde 6 , MD; Teresa Bastante 7 , MD; Ana Marcano 1 , MD; Rafael Romaguera 1 , MD; José-Luis Ferreiro 1 , MD; Gerard Roura 1 , MD; Luis Teruel 1 , MD; Albert Ariza-Solé 1 , MD, PhD; Faustino Miranda-Guardiola 2 , MD; Vera Rodríguez García-Abad 3 , RN; Joan-Antoni Gomez-Hospital 1 , MD, PhD; Fernando Alfonso 7 , MD, PhD; Angel Cequier 1 , MD, PhD 1. Hospital Universitari de Bellvitge, Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), Universitat de Barcelona, L’Hospitalet de Llobregat, Spain; 2. Hospital del Mar, Grup de Recerca Biomèdica en Malalties del Cor, Hospital del Mar Research Institute (IMIM), Barcelona, Spain; 3. Hospital Clínico San Carlos, Madrid, Spain; 4. Hospital Doce de Octubre, Madrid, Spain; 5. Hospital Germans Trias i Pujol, Badalona, Spain; 6. Hospital La Paz, Madrid, Spain; 7. Hospital La Princesa, Madrid, Spain Abstract Aims: Our aim was to describe the intravascular ultrasound (IVUS) findings of patients with late stent thrombosis (ST) undergoing percutaneous intervention, and to compare the pre- and post-intervention IVUS findings of patients treated with balloon angioplasty (BA) vs. additional stent implantation (ASI). Methods and results: A total of 117 patients with late ST imaged with IVUS were included (51.2% had drug-eluting stent ST). Treatment was left to the operator’s discretion: BA was performed in 53.8% and ASI in 46.2%. Pre-intervention, incomplete stent apposition (ISA) was observed in 69.8% vs. 63.0% (p=0.43), underexpansion in 33.3% vs. 18.5% (p=0.07) and restenosis in 15.9% vs. 27.8% (p=0.12), respec- tively. Post-intervention, persistent ISA was observed in 37.2% vs. 60.9% (p=0.03) and malapposition vol- ume decreased by 43.6% vs. 2.6% (p=0.03). Persistent underexpansion was observed in 9.3% vs. 17.4% (p=0.26); however, the stent expansion index was largely increased with BA (from 0.75 to 0.88) compared to ASI (from 0.80 to 0.82); p=0.046. At two years, recurrent ST was observed in one (1.7%) vs. four (7.7%) patients, respectively; p=0.09. Conclusions: Non-optimal IVUS criteria of stent implantation are often observed in patients with late ST. Treatment of late ST with BA leads to a larger reduction of malapposition and underexpansion with respect to ASI and is associated with favourable outcomes. KEYWORDS • intravascular ultrasound • percutaneous coronary intervention • stent thrombosis SUBMITTED ON 30/05/2015 - REVISION RECEIVED ON 1 st 27/07/2015 - 2 nd 10/08/2015 - ACCEPTED ON 15/09/2015