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Evaluation of in-stent neointimal tissue components using integrated backscatter intravascular ultrasound: comparison of drug-eluting stents and bare-metal stents

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Abstract

Although in-stent restenosis (ISR) occurs after drug-eluting stents (DES) implantation, neointimal tissue characteristics have not been fully investigated. We assessed neointimal tissue components using integrated backscatter intravascular ultrasound (IB-IVUS) after DES and bare-metal stents (BMS) implantation. Fifty-seven consecutive patients with 61 lesions underwent repeated percutaneous coronary intervention (PCI) for the treatment of ISR (DES: 24 lesions, BMS: 37 lesions). PCI was performed using plain old balloon angioplasty (POBA). Before PCI, we assessed neointimal tissue characteristics using IB-IVUS. Neointima was divided into four categories: category 1 (−11 to −29 dB), category 2 (−29 to −35 dB), category 3 (−35 to −49 dB), and category 4 (−49 to −130 dB) according to IB values. We compared neointimal tissue components between DES and BMS. Thirty-three patients with 33 lesions (DES: 17, BMS: 16) were finally included. Neointima was predominantly composed of category 3 tissue in both groups (DES: 68 ± 8%, BMS: 73 ± 5%, P = 0.053). DES had a broader distribution of category 4 tissue component than BMS. After POBA, distal slow flow phenomenon occurred in 5 of DES (29%), whereas none of BMS. In DES, the optimal threshold of category 4 tissue to predict distal slow flow phenomenon after POBA was 30% (sensitivity: 100%, specificity: 92%). Neointima was mainly composed of category 3 tissue at ISR site, irrespective of DES or BMS. In DES, there was a subgroup with category 4 rich tissue, which caused distal slow flow phenomenon after POBA. IB-IVUS might be useful to identify vulnerable neointima in DES restenosis.

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Authors and Affiliations

  1. Department of Cardiovascular Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan

    Yoshitaka Muraoka, Shinjo Sonoda, Kuninobu Kashiyama, Fumihiko Kamezaki, Yuki Tsuda, Masaru Araki, Masahiro Okazaki & Yutaka Otsuji

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  1. Yoshitaka Muraoka
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  2. Shinjo Sonoda
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  3. Kuninobu Kashiyama
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  4. Fumihiko Kamezaki
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  5. Yuki Tsuda
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  6. Masaru Araki
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  7. Masahiro Okazaki
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  8. Yutaka Otsuji
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Correspondence to Shinjo Sonoda.

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Muraoka, Y., Sonoda, S., Kashiyama, K. et al. Evaluation of in-stent neointimal tissue components using integrated backscatter intravascular ultrasound: comparison of drug-eluting stents and bare-metal stents. Int J Cardiovasc Imaging 28, 1635–1641 (2012). https://doi.org/10.1007/s10554-011-9997-9

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  • DOI: https://doi.org/10.1007/s10554-011-9997-9

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