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Effect of neointimal tissue morphology on vascular response to balloon angioplasty in lesions with in-stent restenosis after drug-eluting stent deployment: an optical coherence tomography analysis

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Abstract

This study aimed to evaluate the vascular response to balloon angioplasty for drug-eluting stent (DES) in-stent restenosis (ISR) lesions based on our novel optical coherence tomography (OCT) classification to establish the optimal treatment strategy for ISR lesions after DES implantation. A total of 104 ISR lesions after DES implantation were imaged by OCT and categorized into the following six patterns: type I—homogeneous high-intensity tissue, type II—heterogeneous tissue with signal attenuation, type III—speckled heterogeneous tissue, type IV—mixed tissue containing poorly delineated region with invisible strut, type V—mixed tissue containing sharply delineated low-intensity region, and type VI—bright protruding tissue with an irregular surface. Serial volumetric OCT analysis was performed before and after balloon dilation to evaluate the vascular response to balloon angioplasty. After balloon dilation, the minimal decrease in neointimal volume was noted in type I lesions and maximal in type III lesions. In contrast, the increase in stent volume was significantly more in type I lesions than others. Neointimal tissue characterization by OCT allows us to provide useful information about the vascular response to balloon dilation, which can influence the therapeutic strategy for DES ISR lesions.

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Abbreviations

CAG:

Coronary angiography

DES:

Drug-eluting stent

ISR:

In-stent restenosis

MLA:

Minimal lumen area

NIH:

Neointimal hyperplasia

OCT:

Optical coherence tomography

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Acknowledgements

The authors thank the staff in the catheterization laboratory at Higashi Takarazuka Satoh Hospital for their excellent assistance during the study.

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Authors and Affiliations

  1. Department of Cardiology, Higashi Takarazuka Satoh Hospital, Takarazuka, Hyogo,, 6650873, Japan

    Wataru Yamamoto, Kenichi Fujii, Satoru Otsuji, Shin Takiuchi, Mikio Kakishita, Yuji Shimatani, Katsuyuki Hasegawa, Kasumi Ishibuchi, Hiroto Tamaru, Rui Ishii, Shingo Yasuda, Yusuke Taniguchi, Sho Nakabayashi, Hirofumi Kusumoto & Yorihiko Higashino

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  1. Wataru Yamamoto
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  2. Kenichi Fujii
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  3. Satoru Otsuji
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  4. Shin Takiuchi
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  14. Hirofumi Kusumoto
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  15. Yorihiko Higashino
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Correspondence to Kenichi Fujii.

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Yamamoto, W., Fujii, K., Otsuji, S. et al. Effect of neointimal tissue morphology on vascular response to balloon angioplasty in lesions with in-stent restenosis after drug-eluting stent deployment: an optical coherence tomography analysis. Heart Vessels 35, 1193–1200 (2020). https://doi.org/10.1007/s00380-020-01595-z

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  • DOI: https://doi.org/10.1007/s00380-020-01595-z

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