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Optical coherence tomography characteristics of in-stent restenosis after drug-eluting stent implantation: a novel classification and its clinical significance

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Abstract

This study aimed to establish a novel classification of in-stent restenosis (ISR) morphological characteristics after drug-eluting stent (DES) implantation as visualized by optical coherence tomography (OCT) and determine its clinical significance. A total of 133 lesions with intrastent restenosis after DES implantation were imaged by OCT. Neointimal tissue characteristics were categorized according to the classical classification as either homogeneous, heterogeneous, or layered. Then all tissues were also classified into six types as follows: homogeneous high-intensity tissue (type I), heterogeneous tissue with signal attenuation (type II), speckled heterogeneous tissue (type III), heterogeneous tissue containing poorly delineated region with invisible strut (type IV), heterogeneous tissue containing sharply delineated low-intensity region (type V), or bright protruding tissue with an irregular surface (type VI). The kappa value for interobserver agreement between the two observers was higher in the modified classification than in the classical classification (0.97 and 0.72, respectively). Most lesions classified as type V and VI were likely to be identified in patients on hemodialysis and located at the ostial right coronary artery. The duration from stent implantation to ISR was significantly longer in types IV and VI than in others. The incidence of stent fracture was significantly higher in types I and IV. This new modified classification enabled us to classify most ISR lesions easily with higher reproducibility. The clinical significance of neointimal restenotic tissue classification by OCT became clear while using the modified classification.

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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 staffs 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, Motoaki Ibuki, Katsuyuki Hasegawa, Kasumi Ishibuchi, Hiroto Tamaru, Shingo Yasuda, Rui Ishii, 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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  7. Katsuyuki Hasegawa
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  9. Hiroto Tamaru
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  13. Hirofumi Kusumoto
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  14. Yorihiko Higashino
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Correspondence to Kenichi Fujii.

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Yamamoto, W., Fujii, K., Otsuji, S. et al. Optical coherence tomography characteristics of in-stent restenosis after drug-eluting stent implantation: a novel classification and its clinical significance. Heart Vessels 35, 38–45 (2020). https://doi.org/10.1007/s00380-019-01461-7

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  • DOI: https://doi.org/10.1007/s00380-019-01461-7

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