Optical Coherence Tomographic Observation of In-Stent Neoatherosclerosis in Lesions With More Than 50% Neointimal Area Stenosis After Second-Generation Drug-Eluting Stent Implantation

Abstract

A ccording to a previous pathological study using directional coronary atherectomy specimens, the components of neointimal tissue in drug-eluting stent (DES) in-stent restenosis were similar to those of bare-metal stent in-stent restenosis at 4 to 36 months after implantation, and the components were mainly composed of smooth muscle cells.1 Recently, neoatherosclerosis, the atherosclerotic change within neointima, has been introduced as an important variable in both ex-and in-vivo studies. [2][3][4][5][6][7] Neoatherosclerosis is observed more frequently and occurs significantly earlier in DEStreated lesions when compared with bare-metal stent-treated lesions.2-7 Furthermore, compared with patients without neoatherosclerosis, those with neoatherosclerosis have more severe coronary artery disease, such as acute coronary syndrome or stent thrombosis. 5,8 Accordingly, neoatherosclerosis has been regarded as a primary mechanism for late stent failure after DES implantation.9 From recent registry studies with large study populations, the second-generation DES showed similar efficacy, but lower incidence of stent thrombosis compared with the first-generation DES.10,11 However, the development of neoatherosclerosis in second-generation DESs has not been sufficiently evaluated. Although the previous studies suggested several predictors for neoatherosclerosis, it did not compare first-with second-generation DESs or included Background-Despite the enhanced properties of the second-generation drug-eluting stent (DES), its association with neoatherosclerosis has not been sufficiently evaluated. Therefore, we sought to evaluate and compare neoatherosclerosis in second-generation DESs to first-generation DESs. Methods and Results-A total of 212 DES-treated patients with >50% percent neointimal cross-sectional area stenosis were retrospectively enrolled from the Korean multicenter optical coherence tomography (OCT) registry.

Understanding and managing in-stent restenosis: a review of clinical data, from pathogenesis to treatment

“…Atherosclerotic lesions may affect the nascent neointima in the meaning of a new disease known as neoatherosclerosis, responsible for a certain number of stent failures (including ISR, acute coronary syndromes and ST, both for BMS or DES) over the time (39,40). Little is known about the predisposition, pathogenesis and development of neoatherosclerosis.…”

Clinical Characteristics of In-stent Neoatherosclerosis Causing Late Stent Failure

“…Recently, several clinical factors have been reported as predictors of NA including, stent duration, smoking, CKD, DES use, and angiotensin converting enzyme inhibitor/angiotensin II receptor blocker use. [9][10][11] However, these predictive factors…”

“…6,7) The development of optical coherence tomography (OCT) has enabled us to identify in-stent NA, which is characterized by vulnerable plaque features such as lipid laden plaque, thin-cap fibroatheromas (TCFA), and luminal thrombus and therefore, patients with NA have often unstable coronary disease. 8) Previous reports have suggested that elapsed time after stent implantation, smoking, and chronic kidney disease (CKD) are predictors of NA after stent implanatation, [9][10][11] however, the precise mechanism of NA has not been elucidated.…”

Neoatherosclerosis: Inevitable Destination or Next Target?

“…Although a retrospective study has shown a significant association between the presence of neoatherosclerosis and LDL-cholesterol level, 31) there is no prospective study proving the protec- In addition to intracoronary imaging, non-invasive modality to detect neoatherosclerosis is needed for a broad clinical implication. The presence of neoatherosclerosis can be defined only by histopathology or intracoronary imaging modalities at present, specifically OCT and angioscopy, which require considerably invasive procedures.…”