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Long-term changes in neointimal hyperplasia following implantation of bare metal stents assessed by integrated backscatter intravascular ultrasound

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Abstract

In-stent restenosis (ISR) is a common phenomenon with bare metal stents (BMSs) in the early stage after implantation. However, ISR occurs at a lower rate with long time after BMS implantation. We assessed changes over time in neointimal hyperplasia following BMS implantation using integrated backscatter intravascular ultrasound (IB-IUVS). Thirty-six patients who received target lesion revascularization (TLR) to treat ISR were classified according to the duration of the interval between stent implantation and TLR: the early group (within first year n = 25) and the VL group (very late ISR ≥5 years, n = 11). IB-IUVS was used to evaluate within-stent sites from the proximal to the distal edge of the stent. IB-IVUS color maps were then constructed by tracing the stent struts and vessel lumen. Neointimal tissue was classified as high-IB (IB <−29 dB; a representative cord of calcification), middle-IB (−49 dB ≤ IB < −29 dB; fibrosis), or low-IB (−49 dB ≤ IB; lipid pool). We compared percent (%) volume, average %area of cross-sectional area (CSA), and %area of minimum CSA of each component between the groups. There were no significant differences in %volume, average %area of CSA, or %area of minimum CSA for the high-IB component between groups. The %low-IB components were 20.0 ± 8.8 % for volume, 20.1 ± 8.9 % for mean CSA, and 17.6 ± 8.5 % for minimum CSA in the early group. On the other hand, in the VL group, the %low-IB components were significantly increased to 31.8 ± 7.9 % for volume (p < 0.01 vs. the early group), 31.2 ± 7.6 % for mean CSA (p < 0.01 vs. the early group), and 33.1 ± 12.3 % for minimum CSA (p < 0.01 vs. the early group). By contrast, the %middle-IB component showed a reduction in extended time, with %volume of the middle-IB decreasing from 78.3 ± 8.1 to 66.4 ± 7.1 %, average mean %area of CSA from 78.2 ± 8.2 to 66.9 ± 6.9 %, and % area of minimum CSA from 80.7 ± 7.9 to 65.5 ± 11.4 % (p < 0.01;. the early vs. the VL group). Our results suggest that in-stent neointimal tissues developing over time consist of an increased low-IB component and a decreased middle-IB component and may contribute an increased of lipidemic component and a decreased of fibrotic component.

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Acknowledgments

Reiko Matsuoka, MD, Shintaro Abe, MD, Yoshiaki Goto, MD, Takashi Yoshizane, MD, Takashi Kato MD, Tomoko Hirose, MD, Shunichiro Warita, MD, Tai Kojima, MD, Takeshi Hirose, MD and Koji Ono, MD, participated in data collection for this study. We thank Mr. Kaoru Kawasaki and Mr. Yoshiaki Kodera for their technical support with the experimental equipment.

Conflict of interest

None of the authors has any conflicts of interest pertaining to this manuscript, nor any commercial relationships with the products and devices described.

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Authors and Affiliations

  1. Department of Cardiology, Gifu Prefectural General Medical Center, 4-6-1 Noisshiki, Gifu, 500- 8717, Japan

    Shinichiro Tanaka, Toshiyuki Noda, Makoto Iwama, Shintaro Tanihata & Sachiro Watanabe

  2. Second Department of Internal Medicine, Gifu University Graduate School of Medicine, Gifu, Japan

    Masanori Kawasaki, Kazuhiko Nishigaki & Shinya Minatoguchi

  3. Gifu Cardiovascular Institution, Gifu, Japan

    Taro Minagawa

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  1. Shinichiro Tanaka
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  2. Toshiyuki Noda
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Correspondence to Shinichiro Tanaka.

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Tanaka, S., Noda, T., Iwama, M. et al. Long-term changes in neointimal hyperplasia following implantation of bare metal stents assessed by integrated backscatter intravascular ultrasound. Heart Vessels 28, 415–423 (2013). https://doi.org/10.1007/s00380-012-0266-1

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