The clinical characteristics and prognosis of lesions with in-stent eccentric tissue proliferation and strong signal attenuation detected by optical coherence tomography

Abstract

There are still some patients who require repeat revascularization despite of drug-eluting stent (DES) implantation. The present study aimed to investigate the relationship between optical coherence tomography (OCT) findings and recurring target lesion revascularization (TLR) after percutaneous coronary intervention (PCI) for in-stent restenosis (ISR). We reviewed 50 patients (54 coronary lesions) who underwent PCI for ISR, which included 25 DES-ISR lesions. The PCI strategy depended on the interventionalist's discretion, and DES implantation was performed for 38 (70 %) lesions. Tissue characteristics were assessed qualitatively and quantitatively using the frame showing maximal lumen narrowing (minimal lumen area). In qualitative analysis, OCT detected coexistence of eccentric tissue proliferation and strong signal attenuation (ESA). ESA was observed in six lesions (11 %) in five patients (10 %). Hemodialysis (80 vs. 20 %, p = 0.013) and DES-ISR (100 vs. 40 %, p = 0.0069) were significantly more frequent in ESA patients/lesions than in others. One-year follow-up revealed that re-TLR was more frequently performed for ESA lesions (83 vs. 8 %, p = 0.0002). The findings reveal that ESA detected in OCT images of ISR is related to TLR after PCI for DES-ISR especially in patients undergoing maintenance hemodialysis.

Long-Term Clinical and Angiographic Outcomes After Implantation of New-Generation Drug-Eluting Stents for Patients on Maintenance Hemodialysis

“…4) Pathophysiology of restenosis specific to dialysis patients may exist. Late restenosis or calcium-phosphate metabolism 5,6) may be responsible for the poor clinical outcomes in hemodialysis patients.…”

Impact of optical coherence tomography‐derived neointimal tissue morphology on development of very late in‐stent restenosis

“…Previous pathological studies reported that neointima rich in smooth muscle cells and proteoglycans, superficial foam cell accumulation, necrotic core, calcification, and organized thrombus were observed after DES placement . Similarly, clinical OCT studies of patients presenting with in‐stent restenosis have also demonstrated several types of tissues on OCT . Furthermore, the OCT appearance of in‐stent restenosis tissues after DES significantly differed between early and late restenosis phases .…”

“…9,10,15 Previous pathological studies reported that neointima rich in smooth muscle cells and proteoglycans, superficial foam cell accumulation, necrotic core, calcification, and organized thrombus were observed after DES placement. 9,10,15 Similarly, clinical OCT studies of patients presenting with in-stent restenosis have also demonstrated several types of tissues on OCT. 11,16,17 Furthermore, the OCT appearance of in-stent restenosis tissues after DES significantly differed between early and late restenosis phases. 7,8 In line with the findings of a previous study, homogeneous high-intensity signal neointima, which was frequently observed in restenotic lesions that developed within 2 years after deployment, was observed in only 4% of the lesions.…”

Risk factors of in-stent restenosis among coronary artery disease patients with syphilis undergoing percutaneous coronary intervention: a retrospective study

“…Coronary intervention or percutaneous coronary intervention (PCI) is an important therapeutic method for coronary artery disease (CAD) [ 1 ], and in-stent restenosis (ISR) is the most common complication of PCI, which occurs in 3%–20% of patients undergoing coronary stent implantation [ 2 ]. ISR is a key risk factor that affects the prognosis of PCI and is a difficult problem associated with coronary intervention of CAD [ 3 ].…”