Predictors for Neoatherosclerosis

Abstract

Optical coherence tomography (OCT) is an emerging intracoronary diagnostic modality that provides high-resolution images of coronary artery in vivo. 11 In addition to tissue characterization in native coronary plaques, OCT has been applied to characterize neointima after stent implantation. 12 Indeed, several OCT studies revealed the development of lipid-laden neointima inside the stents, and OCT has become the modality of choice to study atherosclerotic change of neointima. 7,9,10 Background-Recent studies have reported development of neoatherosclerosis (NA) inside the stents several years after stent implantation. The aim of this study was to determine the predictors for NA using optical coherence tomography. Methods and Results-From a total of 1080 patients who underwent optical coherence tomography, we identified 179 stents in 151 patients in which the mean neointimal thickness was >100 µm. The presence of lipid-laden neointima or calcification inside the stents was defined as NA in the present study. Patient characteristics, stent type, and time since stent implantation (stent age) were compared between stents with or without NA.

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

“…Neoatherosclerosis is less frequent in BMS as compared with DES, so that the drug released from the latter seems to be one of the causative factors due to the incomplete endothelialization related to the drug itself (43,44).…”

Management and Outcome of Patients With Acute Coronary Syndrome Caused by Plaque Rupture Versus Plaque Erosion: An Intravascular Optical Coherence Tomography Study

“…In light of the relatively well‐preserved vascular structure and less severe luminal narrowing,1, 2, 9 it is conceivable that ACS caused by PE without significant luminal narrowing may be stabilized by effective antithrombotic treatment without stent implantation. This conservative strategy would avoid both early (vessel dissection, distal embolism, and acute stent thrombosis) and late (restenosis, neoatherosclerosis, and late and very late stent thrombosis) complications of stent implantation 10, 11, 12, 13, 14. Indeed, few reports with a small number of cases have suggested that a subset of patients with ST‐segment elevation myocardial infarction caused by PE might be treated by antithrombotic therapy with favorable outcome 2, 15, 16.…”

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.…”