Impact of neointimal tissue characterization and heterogeneity of bare-metal stents and drug-eluting stents on the time course after stent implantation evaluated by integrated backscatter intravascular ultrasound

  • Takashi YoshizaneEmail author
  • Shinichiro Tanaka
  • Shintaro Abe
  • Takahiro Ueno
  • Yoshiaki Goto
  • Tai Kojima
  • Makoto Iwama
  • Masazumi Arai
  • Toshiyuki Noda
  • Masanori Kawasaki
Original Article


Pathological studies have suggested the different process of in-stent restenosis (ISR) of bare-metal stents (BMS) and drug-eluting stents (DES). Here, we evaluated the components of neointimal tissue using integrated backscatter intravascular ultrasound (IB-IVUS) and focused on the time course after stent implantation and tissue signal distribution. We evaluated 125 lesions of 125 patients who underwent target lesion revascularization for ISR (BMS: n = 73, DES: n = 52). Volume analysis of a 4-mm length centered on a minimum lumen area in every 1-mm cross-sectional area was performed. For IB-IVUS analysis, color-coded maps were constructed from the default setting based on the integrated backscatter (IB) values (middle-IB value, green: fibrous and low-IB value, blue: lipid pool). For the neointimal tissue volume, we evaluated the ratios of the green (%G) and blue (%B) areas. Tissue signal distribution (TD) was also obtained from the default setting based on IB values in each pixel of IB-IVUS imaging. We compared values of neointimal tissues measured by IB-IVUS between the DES and BMS and time course. The observed period was longer after BMS implantation than after DES implantation (BMS: 2545 days, DES: 1233 days, p < 0.001). Overall, %G and %B were similar between the BMS and DES groups (%G: 55% and 51%, respectively, p = 0.10; %B: 36% and 38%, respectively, p = 0.51); however, TD was significantly higher in the DES group than in the BMS group (1091 vs. 1367, p < 0.001). TD in the DES group remained high during the follow-up periods. However, TD in the BMS group was low in the early phase and significantly increased over time (r = 0.56, p < 0.001). When analyzing the ISR within 2 years after stent implantation, the BMS was distinguished with a sensitivity of 66% and a specificity of 90% (cut-off value: TD = 1135, area under the curve 0.83, 95% confidence interval 0.74–0.92). TD could differentiate neointimal tissue after BMS implantation in the early phase. TD can be a useful index in the observation of neoatherosclerosis.


Neoatherosclerosis Tissue signal distribution Integrated backscatter intravascular ultrasound Bare-metal stent Drug-eluting stent 



The authors would like to thank Yoshitake Oshima, MD; Syuntaro Horio, MD; Ryota Watanabe, MD; Hiroto Yagasaki, MD; Hirotaka Miwa, MD; Takashi Kato, MD; Syunichiro Warita, MD, PhD; Koji Ono, MD, PhD; and Shintaro Tanihata, MD, PhD for providing assistance in manuscript preparation.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethics approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer Japan KK, part of Springer Nature 2019

Authors and Affiliations

  • Takashi Yoshizane
    • 1
    Email author
  • Shinichiro Tanaka
    • 2
  • Shintaro Abe
    • 1
  • Takahiro Ueno
    • 1
  • Yoshiaki Goto
    • 1
  • Tai Kojima
    • 1
  • Makoto Iwama
    • 1
  • Masazumi Arai
    • 1
  • Toshiyuki Noda
    • 1
  • Masanori Kawasaki
    • 3
  1. 1.Department of CardiologyGifu Prefectural General Medical CenterGifuJapan
  2. 2.Asahi University HospitalGifuJapan
  3. 3.Gifu University Graduate School of MedicineGifuJapan

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