After coronary
stent implantation,
neointima formation resembles the wound healing process as it involves the sequential processes of
inflammation, granulation, and remodeling. Because antiproliferative drugs and
polymers of
drug-eluting stents (DESs) delay vascular healing compared with bare
metal stents,
fibrin deposition can remain long after
stent implantation, or
inflammation can be excessive. Delayed vascular healing can be associated with adverse clinical outcomes including DES
thrombosis or restenosis, and poor endothelization of DES
neointima can accelerate neoatherosclerotic change inside the
neointima, further contributing to
luminal restenosis or neointimal instability. Despite the lack of correlation between pathologic and optical coherence tomography (OCT) findings, OCT assessments of
neointima under various circumstances can reveal vascular responses to
stent therapy. Homogeneous, heterogeneous, and layered
neointima patterns can be recognized by OCT and can change with time. Homogeneous
neointima might be associated with better clinical outcomes after DES implantation, whereas non-homogeneous
neointima or neoatherosclerotic change can be associated with poorer clinical outcomes. However, limited data are currently available, and further studies are required to comprehensively address these questions.