Renal Dysfunction and Atherosclerosis of the Neointima following Bare Metal Stent Implantation

Abstract

Background: Recently, neoatherosclerosis within the neointima after bare metal stent (BMS) implantation, which could cause late restenosis and very late stent thrombosis, has been a cause of concern. Renal dysfunction has been related to late cardiovascular events after coronary intervention. The present study was conducted focusing on the relationship between renal dysfunction and neointimal tissue characteristics with BMS restenosis using integrated backscatter intravascular ultrasound (IB-IVUS). Methods: We prospectively performed IB-IVUS in 80 consecutive patients requiring target lesion revascularization after BMS implantation; the patients were divided into two groups according to the estimated glomerular filtration [eGFR: ≥60 (n = 49) and <60 ml/min/1.73 m² (n = 31)]. Results: Patients with eGFR <60 ml/min/1.73 m² had a significantly higher percentage of lipid tissue volume within the neointima and a lower percentage of fibrous tissue volume than those with eGFR ≥60 ml/min/1.73 m² (23.2 ± 9.4 vs. 18.0 ± 7.0%, p = 0.005, and 75.3 ± 9.3 vs. 80.4 ± 7.0%, p = 0.007, respectively). Using logistic regression analysis, eGFR <60 ml/min/1.73 m² and duration from stent implantation ≥48 months were independent predictors of increased lipid tissue volume within the neointima (odds ratio, 3.93; 95% confidence interval, 1.15-13.46, p = 0.03, and odds ratio, 7.56; 95% confidence interval, 2.02-28.30, p = 0.003, respectively). Conclusions: Lower eGFR levels were associated with greater lipid tissue volume within the neointima after BMS deployment, suggesting the development of atherosclerosis. Renal dysfunction may affect neointimal tissue characteristics and thus leading to an increased risk of late stent failure.

In-stent restenosis of drug-eluting stents: clinical presentation and outcomes in a real-world scenario

“…It was found to be a factor independently associated with ISR presenting as MI [11]. This is likely explained by the increased incidence of neoatherosclerosis and higher lipid content in neointima among patients with CKD [28, 37].…”

Clinical Presentation and Outcomes of Coronary In-Stent Restenosis Across 3-Stent Generations

“…CRF is a predictor of neoatherosclerosis 19 and increased lipid neointimal content after stenting. 21 These characteristics may explain the CRF association with ACS presentation in the BMS era, 2,4 and the late catch-up phenomenon after DES implantation, mainly manifesting as ACS. 22 Together, these findings suggest that the ISR clinical presentation is associated with patient-and not device-related factors.…”

Prognostic Value of Renal Function for Cardiac Events in Patients Without Significant Stenosis on Coronary Computed Tomography Angiography

“…Baber et al ( 22 ) characterized coronary atherosclerotic plaque morphology in CKD patients using intravascular ultrasound and demonstrated that CKD patients have plaque composed of greater necrotic core and less fibrous tissue prone to rupture. Similarly, Hayano et al ( 27 ) demonstrated that impaired renal function was related to higher percentage of lipid volume within the neointima after stent implantation leading to an increased risk of late stent failure. In addition, it has been reported that impaired renal function causes decreased number of smooth muscle cells within the plaque that may cause loss of fibrous cap of plaque ( 28 ).…”