Optical coherence tomography-based evaluation of in-stent neoatherosclerosis in lesions with more than 50% neointimal cross-sectional area stenosis.

Abstract

AIMS:

To use optical coherence tomography (OCT) to evaluate the time course, risk factors, and clinical implication of in-stent neoatherosclerosis.

METHODS AND RESULTS:

The neointimal characteristics of 152 lesions, 128 drug-eluting stents (DESs) and 24 bare metal stents (BMSs), with >50% percent cross-sectional area (CSA) neointimal stenosis were evaluated. Neoatherosclerosis was defined as neointima with presence of lipid or calcification. Neoatherosclerosis was observed in 54 lesions (35.5%, 35 DESs and 19 BMSs). Median time to follow-up was 70.7 months in lesions with neoatherosclerosis (longer than lesions without neoatherosclerosis [13.4 months, p<0.001]): 58.7 months in DES-treated lesions and 129.5 months in BMS-treated lesions (p<0.001). The optimal cut-off time to predict neoatherosclerosis in DES-treated lesions was 30 months with a sensitivity of 91.4% and a specificity of 72.0% (area under curve: 0.839, 95% confidence interval: 0.764-0.898, p<0.001). Independent risk factors for neoatherosclerosis were stent age, use of first-generation DES and hypertension. Patients with neoatherosclerosis (versus without neoatherosclerosis) had a higher rate of target lesion revascularisation (92.6% vs. 77.6%, respectively, p=0.018) and stent thrombosis (14.8% vs. 0%, respectively, p<0.001).

CONCLUSIONS:

Neoatherosclerosis occurred in one-third of stented lesions with >50% percent CSA stenosis of neointima. Late-phase development of neoatherosclerosis might be associated with clinical deterioration of stented lesions.

• Authors: Seung-Yul Lee, Dong-Ho Shin, Gary S Mintz, Jung-Sun Kim, Byeong-Keuk Kim, Young-Guk Ko, Donghoon Choi, Yangsoo Jang, Myeong-Ki Hong
• Journal: EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology (EuroIntervention) Vol. 9 Issue 8 Pg. 945-51 (Dec 2013) ISSN: 1969-6213 [Electronic] France
• PMID: 24384291 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Topics

• Aged
• Aged, 80 and over
• Atherosclerosis (pathology)
• Constriction, Pathologic (pathology)
• Coronary Stenosis (pathology)
• Coronary Vessels (pathology)
• Female
• Follow-Up Studies
• Humans
• Male
• Middle Aged
• Neointima (diagnosis, epidemiology, pathology)
• Stents (adverse effects)
• Time Factors
• Tomography, Optical Coherence (methods)