Skip to main content
SpringerLink
Log in

Neoatherosclerosis assessed with optical coherence tomography in restenotic bare metal and first- and second-generation drug-eluting stents

  • Original Paper
  • Published:
The International Journal of Cardiovascular Imaging Aims and scope Submit manuscript

Abstract

Although reported in bare metal stents (BMS) and first-generation drug-eluting stents (DES), little is known about neoatherosclerosis in second-generation DES. We used optical coherence tomography to evaluate neoatherosclerosis among different stent generations. Overall, 274 in-stent restenosis (ISR) lesions (duration from implantation 56.9 ± 47.2 months) in 274 patients were assessed for the presence of neoatherosclerosis. Neoatherosclerosis was identified in 38.7% of lesions (106/274): 23.0% second-generation DES (38/165), 65.1% first-generation DES (54/83), and 53.8% BMS (14/26). In the neoatherosclerosis cohort (n = 106), more stent underexpansion or fracture/deformation was observed in second-generation DES, whereas thrombus, without plaque rupture, or evagination was more common in first-generation DES. In multivariable analyses, duration from implantation >1 year (OR: 2.44, 95% CI 1.12–5.31; p = 0.03), absence of angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers (OR 1.95, 95% CI 1.10–3.44; p = 0.02) or statins at the time of ISR (OR 3.12, 95% CI 1.42–6.84; p = 0.01), and first-generation vs first-generation DES (OR 5.32, 95% CI 2.82–10.10; p < 0.001) correlated with a higher prevalence of neoatherosclerosis. Duration from implantation <1 year (OR 2.17, 95% CI 1.03–4.55; p = 0.04) and thin fibrous cap, thrombus, or rupture (OR 2.72, 95% CI 1.15–6.39; p = 0.02) were independent predictors for acute coronary syndromes presentation. Neoatherosclerosis is an important ISR mechanism, especially in first generation DES.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Kastrati A, Mehilli J, Pache J et al (2007) Analysis of 14 trials comparing sirolimus-eluting stents with bare-metal stents. N Engl J Med 356:1030–1039

    Article  CAS  PubMed  Google Scholar 

  2. Valgimigli M, Tebaldi M, Borghesi M et al (2014) Two-year outcomes after first- or second-generation drug-eluting or bare-metal stent implantation in all-comer patients undergoing percutaneous coronary intervention: a pre-specified analysis from the PRODIGY study (PROlonging Dual Antiplatelet Treatment After Grading stent-induced Intimal hyperplasia study). JACC Cardiovasc Interv 7:20–28

    Article  PubMed  Google Scholar 

  3. Giacoppo D, Gargiulo G, Aruta P, Capranzano P, Tamburino C, Capodanno D (2015) Treatment strategies for coronary in-stent restenosis: systematic review and hierarchical Bayesian network meta-analysis of 24 randomised trials and 4880 patients. BMJ 351:h5392

    Article  PubMed  PubMed Central  Google Scholar 

  4. Kang SJ, Mintz GS, Akasaka T et al (2011) Optical coherence tomographic analysis of in-stent neoatherosclerosis after drug-eluting stent implantation. Circulation 123:2954–2963

    Article  CAS  PubMed  Google Scholar 

  5. Nakazawa G, Otsuka F, Nakano M et al (2011) The pathology of neoatherosclerosis in human coronary implants bare-metal and drug-eluting stents. J Am Coll Cardiol 57:1314–1322

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Goto K, Zhao Z, Matsumura M et al (2015) Mechanisms and Patterns of Intravascular ultrasound in-stent restenosis among bare metal stents and first- and second-generation drug-eluting stents. Am J Cardiol 116:1351–1357

    Article  PubMed  Google Scholar 

  7. Waksman R, Kitabata H, Prati F, Albertucci M, Mintz GS (2013) Intravascular ultrasound versus optical coherence tomography guidance. J Am Coll Cardiol 62:S32–S40

    Article  PubMed  Google Scholar 

  8. Kyono H, Guagliumi G, Sirbu V et al (2010) Optical coherence tomography (OCT) strut-level analysis of drug-eluting stents (DES) in human coronary bifurcations. EuroIntervention 6:69–77

    Article  PubMed  Google Scholar 

  9. Gonzalo N, Serruys PW, Garcia-Garcia HM et al (2009) Quantitative ex vivo and in vivo comparison of lumen dimensions measured by optical coherence tomography and intravascular ultrasound in human coronary arteries. Rev Esp Cardiol 62:615–624

    Article  PubMed  Google Scholar 

  10. Tearney GJ, Regar E, Akasaka T et al (2012) Consensus standards for acquisition, measurement, and reporting of intravascular optical coherence tomography studies: a report from the international working group for intravascular optical coherence tomography standardization and validation. J Am Coll Cardiol 59:1058–1072

    Article  PubMed  Google Scholar 

  11. Mehran R, Dangas G, Abizaid AS et al (1999) Angiographic patterns of in-stent restenosis: classification and implications for long-term outcome. Circulation 100:1872–1878

    Article  CAS  PubMed  Google Scholar 

  12. Yabushita H, Bouma BE, Houser SL et al (2002) Characterization of human atherosclerosis by optical coherence tomography. Circulation 106:1640–1645

    Article  PubMed  Google Scholar 

  13. Prati F, Guagliumi G, Mintz GS et al (2012) Expert’s OCTRD. Expert review document part 2: methodology, terminology and clinical applications of optical coherence tomography for the assessment of interventional procedures. Eur Heart J 33:2513–2520

    Article  PubMed  PubMed Central  Google Scholar 

  14. Barlis P, Dimopoulos K, Tanigawa J, Dzielicka E, Ferrante G, Del Furia F, Di Mario C (2010) Quantitative analysis of intracoronary optical coherence tomography measurements of stent strut apposition and tissue coverage. Int J Cardiol 141:151–156

    Article  PubMed  Google Scholar 

  15. Radu MD, Raber L, Kalesan B et al (2014) Coronary evaginations are associated with positive vessel remodelling and are nearly absent following implantation of newer-generation drug-eluting stents: an optical coherence tomography and intravascular ultrasound study. Eur Heart J 35:795–807

    Article  CAS  PubMed  Google Scholar 

  16. Inaba S, Mintz GS, Yun KH et al (2014) Mechanical complications of everolimus-eluting stents associated with adverse events: an intravascular ultrasound study. EuroIntervention 9:1301–1308

    Article  PubMed  Google Scholar 

  17. Yonetsu T, Kim JS, Kato K et al (2012) Comparison of incidence and time course of neoatherosclerosis between bare metal stents and drug-eluting stents using optical coherence tomography. Am J Cardiol 110:933–939

    Article  CAS  PubMed  Google Scholar 

  18. Yokoyama S, Takano M, Yamamoto M et al (2009) Extended follow-up by serial angioscopic observation for bare-metal stents in native coronary arteries: from healing response to atherosclerotic transformation of neointima. Circulation Cardiovasc Interv 2:205–212

    Article  Google Scholar 

  19. Otsuka F, Vorpahl M, Nakano M et al (2014) Pathology of second-generation everolimus-eluting stents versus first-generation sirolimus- and paclitaxel-eluting stents in humans. Circulation 129:211–223

    Article  CAS  PubMed  Google Scholar 

  20. Lee SY, Hur SH, Lee SG et al (2015) Optical coherence tomographic observation of in-stent neoatherosclerosis in lesions with more than 50% neointimal area stenosis after second-generation drug-eluting stent implantation. Circulation Cardiovasc Interv 8:e001878

    Article  Google Scholar 

  21. Cook S, Ladich E, Nakazawa G et al (2009) Correlation of intravascular ultrasound findings with histopathological analysis of thrombus aspirates in patients with very late drug-eluting stent thrombosis. Circulation 120:391–399

    Article  PubMed  Google Scholar 

  22. Chakravarty T, White AJ, Buch M et al (2010) Meta-analysis of incidence, clinical characteristics and implications of stent fracture. J Am Coll Cardiol 106:1075–1080

    Article  Google Scholar 

  23. Kuramitsu S, Hiromasa T, Enomoto S et al (2015) Incidence and clinical impact of stent fracture after PROMUS element platinum chromium everolimus-eluting stent implantation. JACC Cardiovasc Interv 8:1180–1188

    Article  PubMed  Google Scholar 

  24. Kang SJ, Lee CW, Song H et al (2013) OCT analysis in patients with very late stent thrombosis. JACC Cardiovasc Imaging 6:695–703

    Article  PubMed  Google Scholar 

  25. Otsuka F, Byrne RA, Yahagi K et al (2015) Neoatherosclerosis: overview of histopathologic findings and implications for intravascular imaging assessment. Eur Heart J 36:2147–2159

    Article  PubMed  Google Scholar 

  26. Taniwaki M, Windecker S, Zaugg S et al (2015) The association between in-stent neoatherosclerosis and native coronary artery disease progression: a long-term angiographic and optical coherence tomography cohort study. Eur Heart J 36:2167–2176

    Article  PubMed  Google Scholar 

  27. Alfonso F, Cuesta J, Bastante T, Aguilera MC, Benedicto A, Rivero F (2016) In-Stent Restenosis Caused by a Calcified Nodule: a Novel Pattern of Neoatherosclerosis. Can J Cardiol 32:830–e1

    Article  PubMed  Google Scholar 

  28. Magalhaes MA, Minha S, Chen F et al (2014) Ppresentation and outcomes of coronary in-stent restenosis across 3-stent generations. Circulation Cardiovasc Interv 7:768–776

    Article  Google Scholar 

Download references

Acknowledgements

The authors thank Dominic P. Francese, MPH, for assistance in preparing the manuscript.

Author information

Authors and Affiliations

  1. Cardiovascular Research Foundation, 1700 Broadway, 9th Floor, New York, NY, 10019, USA

    Lei Song, Gary S. Mintz, Dong Yin, Myong Hwa Yamamoto, Chee Yang Chin, Mitsuaki Matsumura, Ajay J. Kirtane, Manish A. Parikh, Jeffrey W. Moses, Ziad A. Ali & Akiko Maehara

  2. New York-Presbyterian Hospital/Columbia University Medical Center, New York, NY, USA

    Lei Song, Dong Yin, Myong Hwa Yamamoto, Khady Fall, Ajay J. Kirtane, Manish A. Parikh, Jeffrey W. Moses, Ziad A. Ali & Akiko Maehara

  3. Nation Center for Cardiovascular Disease, China Peking Union Medical College, Fuwai Hospital, Beijing, China

    Lei Song & Dong Yin

  4. National Heart Centre Singapore, Singapore, Singapore

    Chee Yang Chin

  5. St. Francis Hospital, Roslyn, NY, USA

    Richard A. Shlofmitz

Authors
  1. Lei Song
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Gary S. Mintz
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Dong Yin
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Myong Hwa Yamamoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Chee Yang Chin
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Mitsuaki Matsumura
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Khady Fall
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Ajay J. Kirtane
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Manish A. Parikh
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Jeffrey W. Moses
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Ziad A. Ali
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Richard A. Shlofmitz
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Akiko Maehara
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Akiko Maehara.

Ethics declarations

Conflict of interest

Lei Song: Research Grant—Boston Scientific. Gary S. Mintz: Consultant—Boston Scientific, ACIST; fellowship/grant support—Volcano, Boston Scientific, InfraReDx; honoraria—Boston Scientific, ACIST. Dong Yin: Research Grant—Boston Scientific. Chee Yang Chin: Honoraria—ACIST. Ajay J. Kirtane: Institutional research grants to Columbia University from Boston Scientific, Medtronic, Abbott Vascular, Abiomed, St. Jude Medical, and Eli Lilly. Manish A. Parikh: Speakers bureau—Abbott Vascular, Boston Scientific, Medtronic, CSI, Corindus; advisory board—Abbott Vascular, Medtronic, Philips. Jeffrey W. Moses: Consultant: Abiomed. Ziad A. Ali: Grant support and Consultant—St. Jude Medical. Richard A. Shlofmitz: Speaker—CSI. Akiko Maehara: Grant support—Boston Scientific, St. Jude Medical for research fellows; consultant—Boston Scientific, OCT Medical Imaging; speaker fee—St. Jude Medical.

Ethical approval

The study complied with the Declaration of Helsinki. Ethics committees of the study sites approved the protocol.

Informed consent

All patients signed written informed consent forms.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 20 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Song, L., Mintz, G.S., Yin, D. et al. Neoatherosclerosis assessed with optical coherence tomography in restenotic bare metal and first- and second-generation drug-eluting stents. Int J Cardiovasc Imaging 33, 1115–1124 (2017). https://doi.org/10.1007/s10554-017-1106-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10554-017-1106-2

Keywords

Search

Navigation