Author + information
- Kenji Miwa,
- Takao Matsubara,
- Toshihiko Yasuda,
- Masaru Inoue,
- Nobuo Ukawa,
- Hirofumi Okada,
- Youhei Yakuta,
- Takao Matsui,
- Honin Kanaya,
- Masa–aki Kawashiri and
- Masakazu Yamagishi
In–stent restenosis (ISR) is generallyconsidered to be a stable process, however, recent pathological studies revealed that neoatherosclerosis in the newly formed neointima after drug–eluting stent (DES) implantation. The aim of this study was to investigate the optical coherence tomography (OCT) spectrum of in–stent neoatherosclerosis within DES–treated lesions that presented with ISR.
Among total of 1012 DES treated leasions in our hospital from 2006 through 2012, ISR was observed in 121 lesions (11.8%). Of these, consecutive 86 DES ISR lesions evaluated using OCT were enrolled (Median follow–up time was 28.3 month).
Overall, 20 lesions (23%) had at least one OCT–defined in–stent thin–cap fibroatheroma (TCFA)–containing neointima and 14 (16%) had at least one in–stent neointimal rupture. Fibrous cap thickness negatively correlated with follow up time (r=–0.398, P=0.012). Compared with DES <30 months after implantation (the best cut–off to predict TCFA–containing neointima), DES ≥30 month after implantation had a higher incidence of TCFA–containing neointima (42% versus 14%, P=0.036), and intraintima neovascularization (72% versus 40%, P=0.031), and tended to have higher incidence of red thrombus. Under these conditions, patients with unstable OCT findings including TCFA–containing neointima, neointimal rupture, or thrombus had significantly higher serum levels of high sensitivity CRP (0.480mg/dl versus 0.178mg/dl, P=0.028) than those without unstable OCT findings.
These findings suggest that in–stent neoatherosclerosis and persistent inflammatory process might be an important mechanism of DES restenosis, especially late after implantation.
Poster Sessions, Expo North
Sunday, March 10, 2013, 9:45 a.m.–10:30 a.m.
Session Title: Intravascular Imaging: IVUS and OCT
Abstract Category: 38. TCT@ACC–i2: Intravascular Imaging and Physiology
Presentation Number: 2108–256
- 2013 American College of Cardiology Foundation