1. Date of download: 6/26/2016 Copyright © The American College of Cardiology. All rights reserved. From: Coronary Responses and Differential Mechanisms of Late Stent Thrombosis Attributed to First- Generation Sirolimus- and Paclitaxel-Eluting Stents J Am Coll Cardiol. 2011;57(4):390-398. doi:10.1016/j.jacc.2010.05.066 Maximal Neointimal Thickness and Prevalence of Unhealed Struts in First-Generation SES and PES Stratified by Implant Duration (A) Bar chart for maximum neointimal thickness in sirolimus-eluting stents (SES) and paclitaxel-eluting stents (PES) without thrombosis. There is a significant increase in maximum neointimal thickness beyond 9 months with further increase after 18 months in PES, whereas a similar but borderline significant trend was observed in SES with a gradual increase in neointimal thickness. *Statistically different from the ≥3 to <9 months category. (B) Bar chart demonstrating the incidence of unhealed stents in SES and PES stratified by duration of the implant (<12 or ≥12 months). Overall, both DES are associated with decreased incidence of unhealed stents deployed for ≤12 months. Notably, however, a significant decrease in incidence of unhealed stents was only observed in DES placed for on-label indications, whereas the majority of those with off-label indications remained unhealed beyond 12 months. Statistical significance: *Statistically significant p < 0.05 <12 months vs. ≥12 months overall and on-label indications. Lesions ≤30 days were excluded from the analysis. Figure Legend:

2. Date of download: 6/26/2016 Copyright © The American College of Cardiology. All rights reserved. From: Coronary Responses and Differential Mechanisms of Late Stent Thrombosis Attributed to First- Generation Sirolimus- and Paclitaxel-Eluting Stents J Am Coll Cardiol. 2011;57(4):390-398. doi:10.1016/j.jacc.2010.05.066 Representative Images of Late Stent Thrombosis in First-Generation SES and Strut Malapposition in PES (A) Histologic sections from sirolimus-eluting stents (SES). A 40-year-old woman who received 2 SES in the left anterior descending artery (LAD) and right coronary artery (RCA) 17 months antemortem died suddenly 4 days after surgical removal of a melanoma (wide excision) (Patient #2 in Table 6). Antiplatelet therapy (aspirin and clopidogrel) was discontinued 5 days before the surgery. Histologic sections of the SES in the LAD showed total thrombotic occlusion and diffuse inflammation (a). Numerous inflammatory cells were observed within the neointimal area (b). Inflammatory reaction predominantly consists of T lymphocytes (c) (CD45RO) and eosinophils (d) (Luna stain). Note that the same reaction was observed in the SES in RCA (e) and severe inflammation resulted in malapposition of stent struts (f). (B) Histologic sections from a paclitaxel-eluting stent (PES) showing malapposition. A 69-year- old man who received a PES in a saphenous vein graft died suddenly 3 months after stent placement (Patient #6 in Table 6). Histologic sections showed thrombotic occlusion in the PES (a, b); note the malapposition secondary to severe fibrin deposition (c). A 48-year-old man with a PES implant in the proximal LAD died suddenly at 40 months (Patient #11 in Table 6). Histologic sections showed thrombotic occlusion of the PES (d). Most struts are malapposed with fibrin deposition underneath the stent struts (e, f). Thr = thrombus. Figure Legend: