Clinical and pathological characteristics of homogeneous and nonhomogeneous tissue of in-stent restenosis visualized by optical coherence tomography

Itoh, Tomonori; Fusazaki, Tetsuya; Kimura, Takeshi; Oikawa, Hiroki; Sasou, Shunichi; Ishikawa, Yu; Goto, Iwao; Komuro, Kentaro; Nakajima, Shigeru; Koeda, Yorihiko; Kaneko, Kenya; Nishiyama, Osamu; Nakamura, Motoyuki; Morino, Yoshihiro

doi:10.1097/mca.0000000000000225

Cited by 6 publications

(7 citation statements)

References 34 publications

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“…However, in homogeneous lesions, the luminal gain was driven primarily by an increase in stent area, whereas in non-homogeneous lesions, it more often resulted from a decrease in neointimal area. 19) These findings suggest that mechanical resistance to balloon dilation can differ among neointimal patterns as assessed by OCT. 20) Figure 3 shows neointimal changes before and after drug-coated balloon angioplasty in patients with DES restenosis.…”

Section: Clinical Implications Of Oct-defined Neointimal Patternsmentioning

confidence: 99%

Formation and Transformation of Neointima after Drug-eluting Stent Implantation: Insights from Optical Coherence Tomographic Studies

2017

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After coronary stent implantation, neointima formation resembles the wound healing process as it involves the sequential processes of inflammation, granulation, and remodeling. Because antiproliferative drugs and polymers of drug-eluting stents (DESs) delay vascular healing compared with bare metal stents, fibrin deposition can remain long after stent implantation, or inflammation can be excessive. Delayed vascular healing can be associated with adverse clinical outcomes including DES thrombosis or restenosis, and poor endothelization of DES neointima can accelerate neoatherosclerotic change inside the neointima, further contributing to luminal restenosis or neointimal instability. Despite the lack of correlation between pathologic and optical coherence tomography (OCT) findings, OCT assessments of neointima under various circumstances can reveal vascular responses to stent therapy. Homogeneous, heterogeneous, and layered neointima patterns can be recognized by OCT and can change with time. Homogeneous neointima might be associated with better clinical outcomes after DES implantation, whereas non-homogeneous neointima or neoatherosclerotic change can be associated with poorer clinical outcomes. However, limited data are currently available, and further studies are required to comprehensively address these questions.

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Section: Clinical Implications Of Oct-defined Neointimal Patternsmentioning

confidence: 99%

Formation and Transformation of Neointima after Drug-eluting Stent Implantation: Insights from Optical Coherence Tomographic Studies

2017

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“…The core-lab evaluation was performed by an independent core laboratory. Clinical follow-up was done at 1,6,8,12 and up to 24 months post-procedure. The study monitoring, data management and report including statistical analysis was performed by and Independent Contract Research Organization.…”

Section: Methodsmentioning

confidence: 99%

“…11 Whereas drug and its dose on the stent remains an important factor influencing neo-endothelial growth, the most important among mechanical factors is the strut thickness of the stent. 12 Lesion length and used stent length are among two important factors that adversely influence the outcomes after PCI as well as in long term. 12 GenXSync™ is a novel platform cobalt chromium stent with hybrid cell design comprising of an intelligent mix of open and close cells.…”

Section: Introductionmentioning

confidence: 99%

“…12 Lesion length and used stent length are among two important factors that adversely influence the outcomes after PCI as well as in long term. 12 GenXSync™ is a novel platform cobalt chromium stent with hybrid cell design comprising of an intelligent mix of open and close cells. This design enables the stent to be more flexible, trackable and deliverable even in the long lesions.…”

Section: Introductionmentioning

confidence: 99%

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Real world experience of GenXSync and trade; sirolimus eluting coronary stent system in patients with long coronary lesions: outcome of the GEL registry

Hiremath

Makhale

Gorlawar³

et al. 2016

Int J Adv Med

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Background:The study aimed to assess the immediate (procedural outcome) and long-term clinical (Cumulative hierarchical MACE up to 2 years) and angiographic outcomes (late lumen loss at 8 months) in the patients undergoing angioplasty with at least one 40 mm GenXSync™ SES. (Indian Study Regulatory ID CTRI/2014/07/004783). Methods: This single centre prospective study included 26 real-world coronary artery disease (CAD) patients with long and very long lesions (38 lesions, 48 stents). All patients were treated with one or more 40 mm GenxSync™ sirolimus eluting stent (SES). All the subjects were followed up for 2 years including angiographic follow-up at 8 months. Angiography data was evaluated and reported by an independent angiographic core-lab. Subset analyses were performed for all 40mm long stents and 40mm with small diameter stents. Results: The procedural success was observed in 94%. The acute gain was 2.25±0.53mm in stent and 2.09±0.71mm in segment despite of long and complex lesions including CTO. At 2 years, there was only 1 (3.84%) MACE (binary restenosis at 8 months) and stent thrombosis. At 8 months late lumen loss was in-segment 0.15±0.30mm and in-stent 0.14±0.17mm (p = 0.06). The 40mm stents subset, revealed acute gain of 2.21±0.58mm in-stent and 2.01±0.74mm in-segment. The late loss was 0.16± 0.31mm and 0.13±0.17mm in-stent and in-segment respectively. In 40mm stent with small diameter subset, the acute gain was 2.19±0.42mm in-stent and 1.69 ± 0.59mm in-segment and late lumen loss was 0.10±0.18mm insegment and 0.13± 0.33mm in-stent. Conclusions:The results of real world long lesions PCI revealed efficacy, safety and procedural success observed with GenXSync™ stent comparable to other reported studies.

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“…In the current study, Itoh et al [7] performed an analysis to objectively assess in-stent tissue using the normalized standard deviation (NSD) of optical intensity signals (OCT-NSD) in 100 lesions with in-stent restenosis (39 drug-eluting stents, 61 bare-metal stents). They reported a prevalence of homogeneous pattern and nonhomogeneous pattern (heterogeneous or layered) of 48 and 52%, respectively, as assessed by a conventional subjective classification after a follow-up period of 3-141 months.…”

mentioning

confidence: 99%

Can optical coherence tomography objectively assess neointimal pattern after stenting?

Minami

Jang

2015

Coronary Artery Disease

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Clinical and pathological characteristics of homogeneous and nonhomogeneous tissue of in-stent restenosis visualized by optical coherence tomography

Abstract: Nonhomogeneous ISR visualized by OCT showed a high OCT-NSD value, which was a useful predictor for nonhomogeneous images. Moreover, the nonhomogeneous ISR image visualized by OCT may show chronic inflammation and fibrin thrombi.

Cited by 6 publications

References 34 publications

Formation and Transformation of Neointima after Drug-eluting Stent Implantation: Insights from Optical Coherence Tomographic Studies

Formation and Transformation of Neointima after Drug-eluting Stent Implantation: Insights from Optical Coherence Tomographic Studies

Real world experience of GenXSync and trade; sirolimus eluting coronary stent system in patients with long coronary lesions: outcome of the GEL registry

Can optical coherence tomography objectively assess neointimal pattern after stenting?

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