Comparison of Chronic Angioscopic Findings of Bare Metal Stents, 1st-Generation Drug-Eluting Stents and 2nd-Generation Drug-Eluting Stents　– Multicenter Study of Intra-Coronary Angioscopy After Stent (MICASA) –

Abstract

1916DAI K et al. Circulation JournalOfficial Journal of the Japanese Circulation Society http://www. j-circ.or.jp Editorial p 1895Coronary angioscopy permits direct visualization of the intracoronary structure. It has been demonstrated that coronary angioscopy is a useful tool for estimating the neointimal coverage (NC) of stent struts, not only quantitatively by showing the coverage grade but also qualitatively by showing the plaque's yellow color (YC) grade. Several studies have compared the angioscopic findings of 2 specific types of stent, but no previous study has reported a comprehensive comparison of the he drug-eluting stent (DES) has dramatically reduced the risk of restenosis and target vessel revascularization as compared with bare metal stents (BMS). 1-3 Because the 1st-generation DES (1st-DES) was used widely around the world, concern was raised of an increased risk of late stent thrombosis after 1st-DES implantation. 4,5 The 2nd-generation DES (2nd-DES) has been designed with the goal of improving safety, efficacy, and device performance. Several clinical studies have demonstrated that 2nd-DES are associated with favorable clinical outcomes, including lower incidence of very late stent thrombosis, than 1st-DES. Background: No previous study has reported a comprehensive comparison of the chronic angioscopic findings after bare metal stent (BMS), and 1st-and 2nd-generation drug-eluting stents (DES).

Differences of Chronic Angioscopic Findings among Stent Types in Patients with or without Diabetes Mellitus: Sub-Analysis of a Japanese Multicenter Registry Study (MICASA)

“…1) We found more homogeneous stent coverage by white neointima and less thrombus with 2nd-DES than 1st-DES, corresponding with the better clinical outcomes in patients receiving 2nd-DES. 2) Diabetes mellitus (DM) is associated with an increased risk of adverse clinical outcomes resulting from more advanced systemic atherosclerosis compared to persons without DM.…”

Coronary Paque Imaging by Coronary Angioscopy-Comparison with the Other Modalities-

“…1B). Furthermore this modality allows evaluation of neointimal coverage (NIC) after stent implantation and NIC was classified into 3 or 4 grades 12,13) (Fig. 1C).…”

“…NIC at 1 year after 2nd-generation DES implantation was more homogeneous with white and less thrombus than that after 1st-generation DES. 13) Another study showed in-stent yellow plaque at 1 year after DES implantation was associated with cardiovascular event. 15) According to the reports of histopathologic validation of coronary angioscopy, yellow plaque had a thinner fibrous cap and a larger lipid core area compared to the white plaque.…”

Angioscopic Assessment of Stent Stability and Neointimal Coverage After Implantation of 2nd-Generation Drug-Eluting Stents – Comparison With Bare-Mental Stents and 1st-Generation Drug-Eluting Stents –

“…Specifically, histopathological examination has revealed lower levels of fibrin, inflammation, and thrombosis inside 2nd-generation DES, 7 and intracoronary imaging data demonstrate greater uniformity and reduced neointimal proliferation, suggesting less persistent inflammation. 8 In this issue of the Journal, Dai et al 9 show angioscopic he use of drug-eluting stents (DES) has markedly reduced the incidence of stent restenosis, but other types of stent failure such as late catch-up phenomenon and very late stent thrombosis have been documented as major concerns after DES implantation. 1 Delayed arterial healing with incomplete endothelialization or persistent inflammatory process with hypersensitivity reactions are reported among the causes of intermediate or late stent failure after DES implantation.…”

“…This is the first multicenter study performing a comprehensive comparison of 2nd-generation DES against BMS and 1st-generation DES in terms of angioscopic findings. 9 It is known that heterogeneous or incomplete neointimal coverage is a risk factor for thrombus formation, 10 and the presence of yellow neointima inside stents is related to neoatherosclerosis progression. 11 Neointimal proliferation in the early phase <1 year after BMS implantation is considered as stable, and complete neointimal coverage (ie, over the stent strut and underlying atherosclerotic tissues) could be achieved.…”