Comparison of in-stent neoatherosclerosis and tissue characteristics between early and late in-stent restenosis in second-generation drug-eluting stents: an optical coherence tomography study

  • Mahmoud Sabbah
  • Kazushige Kadota
  • Azza El-Eraky
  • Hanan M. Kamal
  • Ahmed-Tageldien Abdellah
  • Ahmed El Hawary
Original Paper


Optical frequency domain imaging (OFDI) was utilized to compare the prevalence of neoatherosclerosis (NA) and morphological characteristics of the neointimal tissue in second generation drug eluting stent (G2-DES)-treated lesions between early (<1 year, E-ISR) and late (>1 year, L-ISR) in-stent restenotic phases. Data comparing NA and in vivo tissue characteristics between early and late in-stent restenosis (ISR) after implantation of G2-DES is limited. An OFDI analysis was performed in 50 G2-DESs {35 everolimus-eluting stent [22 cobalt-chromium (CoCr), 13 platinum-chromium (PtCr)], and 15 biolimus-eluting stent [BES]} ISR lesions (46 consecutive patients) undergoing target lesion revascularization, classified as E-ISR (n = 22 lesion) and L-ISR (n = 28 lesion). NA, defined as a neointima formation containing lipids or calcification was observed in fewer than half (24/50) of all ISR lesions with no significant difference between E-ISR and L-ISR lesions (50 vs. 46.4%, p = 0.8). There were also no significant differences in the morphological appearance and tissue characteristics between E-ISR and L-ISR lesions. ISR was more likely to occur earlier [median 8.6 (8.3–8.9) months] after PtCr-EES implantations (12 lesions vs. 1, p < 0.001), while 3/4 of the BES ISR lesions and more than 2/3 of the CoCr-EES ISR lesions were observed after 1 year of implantation [median 21.3 (20.7–27.5) months, p < 0.001]. Acknowledging some limitations, our observations may suggest that the prevalence of neoatherosclerosis and the morphological appearance, and tissue characteristics of G2-DESs restenotic lesions are similar between the early and late restenotic phases. Certain platforms (PtCr-EESs) may have preferentially presented with early ISR.


In-stent restenosis Neoatherosclerosis Optical frequency domain imaging (OFDI) 



Dr. Sabbah was supported by a governmental scholarship for interventional cardiology training and research from Suez Canal University, Egypt.


No external funding or commercial influence was received in order to conduct the current study. The authors are solely responsible for the design and conduct of this study.

Compliance with ethical standards

Conflict of interest



All authors have no relationship, relevant to the content of this paper, to disclose.

Supplementary material

10554_2017_1146_MOESM1_ESM.docx (43 kb)
Supplementary material 1 (DOCX 42 KB)


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Copyright information

© Springer Science+Business Media Dordrecht 2017

Authors and Affiliations

  • Mahmoud Sabbah
    • 1
    • 2
  • Kazushige Kadota
    • 2
  • Azza El-Eraky
    • 3
  • Hanan M. Kamal
    • 1
  • Ahmed-Tageldien Abdellah
    • 1
  • Ahmed El Hawary
    • 1
  1. 1.Department of Cardiology, Faculty of MedicineSuez Canal UniversityIsmailiaEgypt
  2. 2.Department of CardiologyKurashiki Central HospitalKurashikiJapan
  3. 3.Department of Cardiology, Faculty of MedicinePort-Said UniversityPort-SaidEgypt

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