Different Neointimal Pattern in Early vs. Late In-Stent Restenosis and Clinical Outcomes After Drug-Coated Balloon Angioplasty　― An Optical Coherence Tomography Study ―

Abstract

DCB angioplasty is less effective for heterogeneous neointima in DES ISR. OCT-based neointimal evaluation may be helpful in guiding treatment of DES ISR.

Efficacy of drug‐coated balloon angioplasty in early versus late occurring drug‐eluting stent restenosis: A pooled analysis from the randomized ISAR DESIRE 3 and DESIRE 4 trials

“…Interestingly, these data are consistent with previous reports: A recent intravascular imaging study reporting of numerically higher MACE rates in patients with early ISR as compared to patients with late ISR undergoing DCB treatment. Noteworthy, the presence of a heterogeneous neointima was an independent predictor of MACE in this analysis and was reported in almost 30% of patients presenting with early ISR 21 . In line, Zhao et al reports a significant higher clinical event‐rates (MACE) in patients with early‐ISR, mainly driven by higher TLR rates, in patients with DES‐ISR treated with new‐generation DES 22…”

Clinical characteristics of early and late drug-eluting stent in-stent restenosis and mid-term prognosis after repeated percutaneous coronary intervention

“…[ 27 , 28 ] The serum lipid profile might affect the neointimal plaque characteristics and outcomes after PCI. In accordance with previous OCT studies which have found a lower cholesterol level and heterogeneous intima in the E-ISR group, [ 23 , 29 ] our data also show that low-density lipoprotein cholesterol (LDL-C) concentrations differ significantly between the E-ISR and L-ISR groups (2.0 [1.3–2.4] mmol/L vs . 2.3 [1.8–2.9] mmol/L, P = 0.035), and the total cholesterol (TC) tends to be numerically higher in the L-ISR group than the E-ISR group (3.8 [3.3–4.7] mmol/L vs .…”

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

“…In previous studies, heterogeneous neointima had been closely associated with higher target lesion failure rates in non-significant lesions not subjected to any interventions [1,9] and significant ISR lesions treated with DCB compared to non-heterogeneous neointima [2,3]. This study reported that 1) the incidence of TLR and non-TLR differed according to the in-stent neointimal characteristics and 2) patients with heterogeneous neointima with DESs were associated with a higher incidence of non-TLR and TLR.…”

“…The stent and luminal cross-sectional area (CSA) were analyzed, and the neointimal CSA was calculated as the stent CSA minus the luminal CSA. The segment with minimal lumen area (MLA) and maximal neointimal proliferation was considered the representative site of lesions for future clinical follow-up [1,2]. Therefore, the stented segments at the minimal lumen CSA and maximal neointimal CSA were qualitatively assessed to characterize the neointimal tissue as either homogeneous (a uniform signalrich band without focal variation or attenuation), heterogeneous (focally changing optical properties and various backscattering patterns), or layered neointima (layers with different optical properties, namely, an adluminal high-scattering layer and an abluminal low-scattering layer) [4].…”

“…The prognosis of stented lesions may differ according to the in-stent neointimal characteristics observed on optical coherence tomography (OCT) [1][2][3]. In particular, patients who show instent heterogeneous neointimal growth are associated with a higher incidence of target lesion revascularization (TLR) compared with those who show in-stent non-heterogeneous neointimal growth [1,2]. However, the relationship between in-stent neointimal characteristics and native coronary atherosclerosis progression has not been clearly elucidated.…”