No abstract

Background-We report findings from optical coherence tomography (OCT) of in-stent neoatherosclerosis as a cause of drug-eluting stent (DES) failure. Methods and Results-Optical 024).Compared with DES Ͻ20 months after implantation (the best cut-off to predict TCFA-containing neointima), DES Ն20 months after implantation had a higher incidence of TCFA-containing neointima (69% versus 33%, Pϭ0.012) and red thrombi (27% versus 0%, Pϭ0.007). Patients with unstable (versus stable) angina had an increasing number of unstable OCT findings including TCFA-containing neointima, neointima rupture, and thrombus (Pϭ0.027). The rate of agreement between grayscale intravascular ultrasound and OCT for detecting intimal rupture was 50% and for detecting thrombus was 44%. The agreement between virtual histology intravascular ultrasound and OCT for identifying TCFA-containing neointima was 78%. Conclusions-In-stent neoatherosclerosis may be an important mechanism of DES failure, especially late after implantation.