Author + information
- Marcos García-Guimaraes1,
- Ramon Maruri-Sanchez1,
- Alberto Vera1,
- Javier Cuesta2,
- Fernando Rivero3 and
- Fernando Alfonso4
Neoatherosclerosis (NA) is a major cause of in-stent restenosis (ISR). Optical coherence tomography (OCT) depicted different patterns of NA, including calcified sheets within the stent. Our aim was to describe the prevalence and predictors of calcified neoatherosclerosis (cNA).
We identified patients with a significant ISR (>50% DS within stent or in 5 mm pre or post) and evidence of ischaemia. OCT was performed before stent implantation. Predominant pattern of ISR by OCT was defined at zone of minimal lumen area, as well as frames 3 mm pre and post. Neointimal hyperplasia was defined as high volume homogeneous-signal tissue. Non-calcified NA was defined as thin-cap fibroatheroma or a lipid-laden neointima, while cNA as calcified sheet within the stent.
From January 2014 to August 2016, we identified 81 restenotic lesions (75 patients) evaluated by OCT. In 16% of them, cNA was the predominant pattern of ISR, being all very-late ISR. Those patients with cNA were older (71 ± 9 years vs 66 ± 10 years, p=0.0157), with worse LDL control (97 ± 29 mg/dL vs 81 ± 30 mg/dL, p=0.0746) and with less percentage of treatment with statins (54% vs 85%, p=0.006) and angiotensin-converting-enzyme inhibitors/ angiotensin receptor blockers (ACEi/ARB) (31% vs 65%, p=0.003). Absence of treatment with statins (odds ratio 12.6, 95% CI, 1.7-92, p=0.012) or ACEi/ARB (odds ratio 6.2, 95% CI, 1.01-38, p=0.048) were independently associated with cNA.
One fifth of the patients with clinical ISR showed cNA. The absence of previous treatment with statins or ACEi/ARB is independently associated with cNA.
IMAGING: Imaging: Intravascular