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

Lee, Seung Yul; Hong, Myeong Ki; Jang, Yangsoo

doi:10.4070/kcj.2017.0157

Cited by 23 publications

(18 citation statements)

References 36 publications

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“…Balloon dilatation and stent implantation are associated with vascular injury followed by repair processes that include endothelialisation and neointimal formation [24]. The vascular wall injury causes activation of the inflammatory response to mechanical stretch, endothelial denudation, and subintimal haemorrhage [25].…”

Section: General Mechanism Of Restenosismentioning

confidence: 99%

Pathogenesis and Clinical Significance of In-Stent Restenosis in Patients with Diabetes

Jakubiak

Pawlas

Cieślar

et al. 2021

IJERPH

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Diabetes mellitus (DM) is a strong risk factor for the development of cardiovascular diseases such as coronary heart disease, cerebrovascular disease, and peripheral arterial disease (PAD). In the population of people living with DM, PAD is characterised by multi-level atherosclerotic lesions as well as greater involvement of the arteries below the knee. DM is also a factor that significantly increases the risk of lower limb amputation. Percutaneous balloon angioplasty with or without stent implantation is an important method of the treatment for atherosclerotic cardiovascular diseases, but restenosis is a factor limiting its long-term effectiveness. The pathogenesis of atherosclerosis in the course of DM differs slightly from that in the general population. In the population of people living with DM, more attention is drawn to such factors as inflammation, endothelial dysfunction, platelet dysfunction, blood rheological properties, hypercoagulability, and additional factors stimulating vascular smooth muscle cell proliferation. DM is a risk factor for restenosis. The purpose of this paper is to provide a review of the literature and to present the most important information on the current state of knowledge on mechanisms and the clinical significance of restenosis and in-stent restenosis in patients with DM, especially in association with the endovascular treatment of PAD. The role of such processes as inflammation, neointimal hyperplasia and neoatherosclerosis, allergy, resistance to antimitotic drugs used for coating stents and balloons, genetic factors, and technical and mechanical factors are discussed. The information on restenosis collected in this publication may be helpful in planning further research in this field, which may contribute to the formulation of more and more precise recommendations for the clinical practice.

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Section: General Mechanism Of Restenosismentioning

confidence: 99%

Pathogenesis and Clinical Significance of In-Stent Restenosis in Patients with Diabetes

Jakubiak

Pawlas

Cieślar

et al. 2021

IJERPH

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“…Both BMS-ISR and DES-ISR have the same traditional mechanisms for pathogenesis, including biological, mechanical, and technical factors ( 24 ). Although DESs minimize the neointimal proliferation and improve the healing process after stent implantation compared to BMSs, high sensitivity to polymers and drugs, local inflammation, and delayed healing may still cause neointimal formation ( 25 ).…”

Section: Discussionmentioning

confidence: 99%

The Predictive Value of the Perivascular Adipose Tissue CT Fat Attenuation Index for Coronary In-stent Restenosis

Qin

Zhou

et al. 2022

Front. Cardiovasc. Med.

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ObjectivesTo investigate the association between the perivascular adipose tissue (PVAT) fat attenuation index (FAI) derived from coronary computed tomography angiography (CCTA) and the prevalence of in-stent restenosis (ISR) in patients with coronary stent implantation.MethodsA total of 117 patients with previous coronary stenting referred for invasive coronary angiography (ICA) were enrolled in this retrospective observational analysis. All patients underwent CCTA between July 2016 and November 2021. The deep learning-based (DL-based) method was used to analyze and measure the peri-stent FAI value. Additionally, the relationship between hematological and biochemical parameters collected from all the patients was also explored. The least absolute shrinkage and selection operator (LASSO) method was applied to the most useful feature selection, and binary logistic regression was used to test the association between the selected features and ISR. The predictive performance for ISR of the identified subgroups was evaluated by calculating the area under the curve (AUC) of receiver operator curves plotted for each model. The Pearson correlation coefficient was used to assess the correlation of peri-stent FAI values with degrees of ISR.ResultsThe peri-stent FAI values in the ISR group were significantly higher than those in the non-ISR group (−78.1 ± 6.2 HU vs. −87.2 ± 7.3 HU, p < 0.001). The predictive ISR features based on the LASSO analysis were peri-stent FAI, high-density lipoprotein cholesterol (HDL-C), apolipoprotein A1 (ApoA1), and high-sensitivity c-reactive protein (hs-CRP), with an AUC of 0.849, 0.632, 0.620, and 0.569, respectively. Binary logistic regression analysis determined that peri-stent FAI was uniquely and independently associated with ISR after adjusting for other risk factors (odds ratio [OR] 1.403; 95% CI: 1.211 to 1.625; p < 0.001). In the subgroup analysis, the AUCs of the left anterior descending coronary artery (LAD), left circumflex coronary artery (LCx), and right coronary artery (RCA) stents groups were 0.80, 0.87, and 0.96, respectively. The Pearson's correlation coefficient indicated a term moderately correlation between ISR severity and peri-stent FAI values (r = 0.579, P < 0.001).ConclusionsThe peri-stent FAI can be used as an independently non-invasive biomarker to predict ISR risk and severity after stent implantation.

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“…We found a heterogeneous neointimal pattern in the "Low LDL-C/Apo B" group more frequently than in the "High LDL-C/Apo B" group. A heterogeneous pattern is often associated with vascular inflammation induced by the stent with smooth cells in a rich extracellular matrix, whereas a layered pattern is correlated with a healed neointimal erosion and rupture and peri-strut neovascularization with smooth muscle cells in a rich extracellular matrix 30) . Therefore, those non-homogeneous patterns are often identified among the ISR lesions associated with DESs 31) .…”

Section: Effect Of the "Low Ldl-c/apo B Ratio" On The Neointimal Characteristics Observed By Oct And Cas After Third-generation Des Implamentioning

confidence: 99%

Clinical Importance of the LDL-C/Apolipoprotein B Ratio for Neointimal Formation after Everolimus-Eluting Stent Implantations

Akutsu

Hori

Mizobuchi

et al. 2022

JAT

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Smaller low-density lipoprotein (LDL) particle size has been suggested to result in the development of endothelial dysfunction, atherosclerosis, and in-stent restenosis (ISR); however, little is known regarding the impact of the LDL particle size on the neointima formation leading to ISR after everolimus-eluting stent (EES) implantation.Methods: In this study, we have included 100 patients to examine the relationship between an LDL-C/ apolipoprotein B (Apo B) ≤ 1.2, reportedly representing the LDL particle size, and the neointimal characteristics using optical coherence tomography (OCT) and coronary angioscopy (CAS) during the follow-up coronary angiography (CAG) period (8.8 2.5 months) after EES implantation. We divided them into two groups: LDL-C/Apo B ≤ 1.2 group (low LDL-C/Apo B group, n 53) and LDL-C/Apo B 1.2 group (high LDL-C/Apo B group, n 47). Results:The low LDL-C/Apo B group had a significantly larger neointimal volume (12.8 5.3 vs. 10.3 4.9 mm 3 , p 0.021) and lower incidence of a neointimal homogeneous pattern (71 vs. 89 %), higher incidence of a neointimal heterogeneous pattern (25 vs. 9 %) (p 0.006) and higher prevalence of macrophage accumulation (9 vs. 2 %) (p 0.030) as assessed via OCT, and, as per the CAS findings, a higher prevalence of yellow grade ≥ 2 (grade 2; adjusted residual: 2.94, grade 3; adjusted residual: 2.00, p 0.017) than the high LDL-C/Apo B group. Conclusions:A low LDL-C/Apo B ratio was found to be strongly associated with neointimal proliferation and neointimal instability evidenced chronically by OCT and CAS. An LDL-C/Apo B ≤ 1.2 will be of aid in terms of identifying high-risk patients after EES implantation.(sd-LDL-C). The sd-LDL-C has been often associated with atherosclerosis lipoproteins because of its low affinity for the LDL receptors, easy penetrance into the vessel walls, long blood half-life, and high oxidizability 1) . Numerous reports have suggested a relationship between sd-LDL-C and the onset of cardiovascular diseases (CVDs) 2-4) , but a direct measurement of sd-LDL-C has not been widely used Copyright©2021 Japan Atherosclerosis Society This article is distributed under the terms of the latest version of CC BY-NC-SA defined by the Creative Commons Attribution License.

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

Cited by 23 publications

References 36 publications

Pathogenesis and Clinical Significance of In-Stent Restenosis in Patients with Diabetes

Pathogenesis and Clinical Significance of In-Stent Restenosis in Patients with Diabetes

The Predictive Value of the Perivascular Adipose Tissue CT Fat Attenuation Index for Coronary In-stent Restenosis

Clinical Importance of the LDL-C/Apolipoprotein B Ratio for Neointimal Formation after Everolimus-Eluting Stent Implantations

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