Author + information
- Received July 26, 2010
- Revision received December 6, 2010
- Accepted January 5, 2011
- Published online March 15, 2011.
- Gaku Nakazawa, MD⁎,
- Fumiyuki Otsuka, MD⁎,
- Masataka Nakano, MD⁎,
- Marc Vorpahl, MD⁎,
- Saami K. Yazdani, PhD⁎,
- Elena Ladich, MD⁎,
- Frank D. Kolodgie, PhD⁎,
- Aloke V. Finn, MD† and
- Renu Virmani, MD⁎,⁎ ()
- ↵⁎Reprint requests and correspondence:
Dr. Renu Virmani, CVPath Institute, Inc., 19 Firstfield Road, Gaithersburg, Maryland 20878
Objectives Human coronary bare-metal stents (BMS) and drug-eluting stents (DES) from autopsy cases with implant duration >30 days were examined for the presence of neointimal atherosclerotic disease.
Background Neointimal atherosclerotic change (neoatherosclerosis) after BMS implantation is rarely reported and usually occurs beyond 5 years. The incidence of neoatherosclerosis after DES implantation has not been reported.
Methods All available cases from the CVPath stent registry (n = 299 autopsies), which includes a total of 406 lesions—197 BMS, 209 DES (103 sirolimus-eluting stents [SES] and 106 paclitaxel-eluting stents [PES])—with implant duration >30 days were examined. Neoatherosclerosis was recognized as clusters of lipid-laden foamy macrophages within the neointima with or without necrotic core formation.
Results The incidence of neoatherosclerosis was significantly greater in DES lesions (31%) than BMS lesions (16%; p < 0.001). The median stent duration with neoatherosclerosis was shorter in DES than BMS (DES, 420 days [interquartile range [IQR]: 361 to 683 days]; BMS, 2,160 days [IQR: 1,800 to 2,880 days], p < 0.001). Unstable lesions characterized as thin-cap fibroatheromas or plaque rupture were more frequent in BMS (n = 7, 4%) than in DES (n = 3, 1%; p = 0.17), with relatively shorter implant durations for DES (1.5 ± 0.4 years) compared to BMS (6.1 ± 1.5 years). Independent determinants of neoatherosclerosis identified by multiple logistic regression included younger age (p < 0.001), longer implant durations (p < 0.001), SES usage (p < 0.001), PES usage (p = 0.001), and underlying unstable plaques (p = 0.004).
Conclusions Neoatherosclerosis is a frequent finding in DES and occurs earlier than in BMS. Unstable features of neoatherosclerosis are identified for both BMS and DES with shorter implant durations for the latter. The development of neoatherosclerosis may be yet another rare contributing factor to late thrombotic events.
CVPath Institute provided full support for this work. Dr. Finn is supported by National Institutes of Health grant HL096970-01A1, the Carlyle Fraser Heart Center at Emory University, and a sponsored research agreement with Medtronic and St. Jude Medical; and is a consultant for Abbott Vascular and Cordis. Dr. Virmani receives research support from Medtronic AVE, Abbott Vascular, Atrium Medical, OrbusNeich Medical, Terumo Corporation, Cordis Corporation, BioSensors International, Biotronik, and Alchimedics; and is a consultant for Medtronic AVE, Abbott Vascular, W.L. Gore, Atrium Medical, and Lutonix. All other authors have reported that they have no relationships to disclose. Drs. Nakazawa and Otsuka contributed equally to this work.
- Received July 26, 2010.
- Revision received December 6, 2010.
- Accepted January 5, 2011.
- American College of Cardiology Foundation