Contribution of Poststent Irregular Protrusion to Subsequent In-Stent Neoatherosclerosis after the Second-Generation Drug-Eluting Stent Implantation

Abstract

Previous optical coherence tomography (OCT) study reported that irregular protrusion (IP) post drug-eluting stent (DES) implantation was an independent predictor of clinical outcome; however, the relationship between IP and the presence of subsequent in-stent neoatherosclerosis remains unclear. This study aimed to assess the relationship between IP and in-stent neoatheroscrerosis formation using OCT. We evaluated 83 patients (101 lesions) who underwent second-generation DES implantation and 8-month follow-up (8M-FU) using OCT. Lesions were divided into two groups in presence of IP (IP: n = 43, non-IP: n = 58). At prepercutaneous coronary intervention (pre-PCI), lipid-rich plaque, lesions with positive remodeling, and in-stent thrombus formation were more frequent in IP than in non-IP. On multivariate analysis, the thrombus at pre-PCI and the lesions with positive remodeling were independent predictors of IP. At 8M-FU, heterogeneous neointima, microvessel, lipid-laden neointima, and thin-cap fibro-atheroma like neointima were more frequent in IP than in non-IP (respectively, P < 0.05). On multivariate analysis, IP was associated with heterogeneous neointima. Binary restenosis was more frequent and late lumen loss tended to be larger in IP than in non-IP (19% versus 5%, P = 0.04; 1.25 ± 1.24 mm versus 0.91 ± 0.63 mm, P = 0.09); however, the target lesion revascularization rate was similar in both groups at 8M-FU. In conclusion, our study suggested that poststent IP was associated with subsequent neoatherosclerosis formation at 8M-FU after the second-generation DES implantation.

Correlation between pre‐procedural plaque morphology and patterns of in‐stent neointimal hyperplasia at 1‐year follow‐up in patients treated with new‐generation drug‐eluting stents: An optical coherence tomography based analysis

“…The divergence can be caused by limited follow‐up duration and small sample size. A previous study has reported that irregular protrusion post DES implantation was associated with subsequent heterogeneous neointima at 8‐month follow‐up . Higher vessel curvature after stent implantation may also have an potential impact on the neointimal healing with a higher incidence of heterogeneous neointima .…”

A Novel Rabbit Model for In-Stent Neoatherosclerosis

“…Compared with the traditional method, 12) our method is a fundamental improvement; two incisions of only 3 cm each replace the large incision, reducing bleeding and infection. The traditional method requires the separation of all the branches of the carotid artery, and damage to the muscle tendons, thyroid gland, and parotid gland is difficult to avoid.…”

“…Moreover, there may be too many clamps to clip the branch of the carotid artery successfully, and that may also increase the risk of bleeding. 12,19,20) On the other hand, the new method decreases postoperative pain. The traditional method ligates the punctured artery, causing blood loss to the area nourished by this branch, and the new method avoids this.…”

“…Besides, other researchers reported that irregular protrusion post-DES implantation and stent fracture were also associated with subsequent neoatherosclerosis formation. 12,13) However, certain mechanisms of neoatherosclerosis are still unclear, so we should attach more importance to the further study of neoatherosclerosis, and an appropriate animal model that allows clear scanning of the arterial wall is required.…”

“…Finally, the two ends of the incision are ligated to stop the bleeding. 12) Another method is to separate the common carotid artery and perform aortic arteriography on the bilateral common carotid arteries by transcatheterization of the right femoral artery with a cut-down technique. 13) However, both of these models have disadvantages.…”