Association between in-stent neointimal characteristics and native coronary artery disease progression

Abstract

Background and aims The prognosis of stented lesions differs according to in-stent neointimal characteristics on optical coherence tomography (OCT). In particular, patients who show in-stent heterogeneous neointima are associated with a higher incidence of target lesion revascularization (TLR) compared with those who show in-stent non-heterogeneous neointima. However, the relationship between in-stent neointimal characteristics and native coronary atherosclerosis progression has not been clearly elucidated. The study aimed to investigate the relationship between in-stent neointimal characteristics and progression of native atherosclerosis. Methods The neointimal characteristics of 377 patients with 377 drug-eluting stents (DESs) were quantitatively and qualitatively assessed using OCT. The OCT-based neointima was categorized as homogeneous (n = 207), heterogeneous (n = 93), and layered (n = 77). The relationship of non-target lesion revascularization (non-TLR) with neointimal characteristics was evaluated after OCT examination of the stents. Results After a median follow-up duration of 40.0 months, patients with heterogeneous neointima showed significantly higher non-TLR rates than those with homogeneous neointima and tended to have higher non-TLR rates than those with layered neointima (heterogeneous vs. homogeneous:14.0% vs. 8.7%, p = 0.046; heterogeneous vs. layered neointima:14.0% vs. 7.8%, p = 0.152). Multivariate analysis showed that the independent determinants for non-TLR were heterogeneous neointima (HR: 2.237, 95% CI: 1.023–4.890, p = 0.044) and chronic kidney disease (hazard ratio [HR]: 8.730, 95% CI: 2.175–35.036, p = 0.002). Conclusions The heterogeneous neointima in DES-treated lesions was associated with a higher incidence of non-TLR and target lesion failure. This finding suggests that the neointimal pattern may reflect the progression of the native lesion.

Optical Coherence Tomography Findings in Patients Presenting With In-Stent Restenosis: A Prospective Observational Study of Patterns of Neointimal Hyperplasia and Associated Risk Factors

“…These findings are in line with the previous studies of Kim et al [9] where minimal lumen CSA was 4.5 ± 1.6 mm 2 and 4.0 ± 1.9 mm 2 . MLD was reported as 1.38 ± 0.33 mm and 1.36 ± 0.42 mm, which coincides with the previous study of Jung et al [11] where the mean lumen diameter was 1.1 ± 0.4 mm and 1.2 ± 0.4 mm. NIH in our study was 54.54 ± 11.23 and 59.26 ± 8.86.…”

“…This observation is suggestive of differential prognosis of stented lesions according to in-stent neointimal characteristics [9]. Although previous studies have explored correlations between neointimal patterns, underlying stent type, and restenosis phase, the degree of intralesional neointimal characteristics has not been elucidated [5,10,11]. Therefore, this study sought to qualitatively and quantitatively assess neointimal characteristics of lesions using OCT in patients presenting with ISR.…”

DeepNeo: Deep Learning for neointimal tissue characterization using optical coherence tomography

“…Several studies have demonstrated that subjects with neointima characterized as heterogenous have a higher risk of clinical events compared to subjects with homogenous neointima [13,27]. Additionally, heterogenous neointima might also reflect a more atherogenic milieu per se as it is associated with progression of native atherosclerosis as well [28]. Hence, heterogenous In addition, the interface includes a pullback analysis (D) that provides a detailed analysis of the OCT images and a manual correction feature (E) to correct beginning and end of the stent if necessary.…”

Advantages and prospects of optical coherence tomography in interventional therapy of coronary heart disease (Review)

“…The new plaque is at a certain distance from the trabecula of the stent, which is similar to the occurrence of coronary plaque in situ . An OCT study demonstrated that the progression of neointimal atherosclerosis after stent implantation is associated with the progression of an in situ plaque in the autologous coronary artery ( 60 ). This result is expected, as the new plaque has the same risk as the in situ plaque.…”