Different Neoatherosclerosis Patterns in Drug-Eluting- and Bare-Metal Stent Restenosis　― Optical Coherence Tomography Study

• Published in: Circulation Journal Vol. 83; no. 2; pp. 313 - 319
• Main Authors: Nakamura, Daisuke, Yasumura, Keisuke, Nakamura, Hitoshi, Matsuhiro, Yutaka, Yasumoto, Koji, Tanaka, Akihiro, Matsunaga-Lee, Yasuharu, Yano, Masamichi, Yamato, Masaki, Egami, Yasuyuki, Shutta, Ryu, Sakata, Yasushi, Tanouchi, Jun, Nishino, Masami
• Format: Journal Article
• Language: English
• Published: Japan The Japanese Circulation Society 25.01.2019
• Subjects: Aged; Aged, 80 and over; Atherosclerosis - diagnostic imaging; Atherosclerosis - therapy; Coronary Restenosis - etiology; Coronary Restenosis - therapy; Drug-Eluting Stents - standards; Female; Humans; In-stent restenosis; Male; Middle Aged; Neoatherosclerosis; Neointima - diagnostic imaging; Neointima - pathology; Optical coherence tomography; Stents - standards; Tomography, Optical Coherence - methods; Optical coherence tomography; In-stent restenosis; Neoatherosclerosis
• ISSN: 1346-9843; 1347-4820
• DOI: 10.1253/circj.CJ-18-0701

Background: There are few reports about the differences between drug-eluting stents (DES) and bare metal stents (BMS) in neoatherosclerosis associated with in-stent restenosis (ISR), so we compared the frequency and characteristics of neoatherosclerosis with ISR evaluated by optical coherence tomography (OCT) in the present study. Methods and Results: Between March 2009 and November 2016, 98 consecutive patients with ISR who underwent diagnostic OCT were enrolled: 34 patients had a BMS, 34 had a 1st-generation DES, and 30 had a 2nd-generation DES. Neoatherosclerosis was defined as a lipid neointima (including a thin-cap fibroatheroma [TCFA] neointima, defined as a fibroatheroma with a fibrous cap <65 µm) or calcified neointima. As a result, lipid neointima, TCFA neointima and calcified neointima were detected in 39.8%, 14.3%, and 5.1%, respectively, of all patients. The frequency of neoatherosclerosis was significantly greater with DES than BMS (48.4% vs. 23.5%, P=0.018). The minimum fibrous cap thickness was significantly thicker with DES than BMS (110.3±41.1 µm vs. 62.5±17.1 µm, P<0.001). In addition, longitudinal extension of neoatherosclerosis in the stented segment was less with DES than BMS (20.2±15.1% vs. 71.8±27.1%, respectively, P=0.001). Conclusions: OCT imaging demonstrated that neoatherosclerosis with ISR was more frequent with DES than BMS and its pattern exhibited a more focal and thick fibrous cap as compared with BMS.