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

Abstract

Instruction: Several factors affect the in-stent intimal healing process after drugeluting stents (DESs) implantation. We hope to investigate the influence of plaque characteristics on subsequent heterogeneous neointimal hyperplasia (NIH) using optical coherence tomography (OCT). Methods:The study population consisted 217 patients with single-vessel de novo lesions who underwent both pre-procedural OCT scan and 12-month follow-up OCT examination. NIH is defined as at least five consecutive cross-sectional images with no less than 100μm neointimal thickness. According to OCT follow-up, patients were divided into three groups: neointima-covered group, homogeneous, and heterogeneous NIH group.Results: 102 patients were categorized in neointima-covered group, 91 and 24 patients in homogeneous and heterogeneous group, respectively. Time interval between OCT scans was similar (P = 0.55). No significant differences in the patients' age, gender, comorbidities, laboratory findings, procedural, and lesion-related findings were found among these three groups. Heterogeneous group tended to have more subjects presented as acute coronary syndrome (ACS) (P = 0.04) and mean macrophage grade was higher in this group (P = 0.01). While no statistically significant difference concerning mean intimal thickness (P = 0.21) or neointimal burden (P = 0.73) was found between homogeneous and heterogeneous group. Multivariate logistic regression analysis showed that mean macrophage grade (OR: 2.26, 95%CI:1.12 to 4.53, P = 0.02) and initial clinical presentation of ACS (OR: 2.81, 95%CI: 1.03 to 7.72, P = 0.04) were significant independent risk factors for heterogeneous NIH. Shun-yi Shi and Kai-lun Chen equally contributed to this study. J Interv Cardiol. 2018;31:737-746. wileyonlinelibrary.com/journal/joic Conclusion: Mean macrophage grade measured by OCT as a semi-quantitative morphological risk factor, as well as clinical presentation of ACS, was associated with in-stent neointimal heterogeneity after DES implantation. K E Y W O R D S drug-eluting stents, heterogeneous neointimal hyperplasia, optical coherence tomography, plaque characteristics

Retrospective analysis of OCT on MB characteristics and 1-year follow-up of the ISR incidence after the DES implantation in patients with MB

“…MBs are mostly found in the middle segment of the LAD, and the result was similar to our finding. Unlike CAG, OCT could not only identify MB but also the plaque character 20 . Xu and his colleges have reported that stable fibrous plaques, but no lipid or other types of plaque, were found in the MB segment of all 12 patients under the guidance of OCT 21 .…”

“…However, the etiology of this phenomenon is not clear. OCT is a novel imaging technology based on light, which can be used to study tissues in vivo 20 . Its ultra-high resolution is about 10 µm, which can display the anatomical structure of the coronary artery and provide a high-quality coronary artery image 20 .…”

“…OCT is a novel imaging technology based on light, which can be used to study tissues in vivo 20 . Its ultra-high resolution is about 10 µm, which can display the anatomical structure of the coronary artery and provide a high-quality coronary artery image 20 . Xu and his team have reported that the length of the MB measured by OCT appeared much longer than that measured by CAG, and the maximal extent of MB stenosis appeared significantly small with OCT compared to CAG, indicating that OCT can more clearlyobserve the morphology and intimal structure of MB than CAG 21 .…”

“…Calcified plaque is defined as a plaque with a delineated, signal-poor region with low backscatter. Lipid plaque refers to the plaque with a diffusely bordered, signal-poor region with rapid signal attenuation 20 .

Figure 3 The representative case was about the dynamic observation of the MB change detected by OCT through 1-year follow-up.

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Effect of Rivaroxaban and Clopidogrel Combination Therapy on In-Stent Responses After Everolimus-Eluting Stent Implantation in a Porcine Coronary Model

“…Recent clinical trials have demonstrated that rivaroxaban reduces mortality and cardiovascular events, including stent thrombosis, in patients with regarding neointimal growth and indicated different time courses for vascular response between DAPT and CR or AR treatments. Since the heterogeneous pattern is thought to be linked to poor long-term prognoses [40][41][42] , a lower proportion of heterogeneous patterns in AR and CR might indicate a beneficial effect. The high proportion of layered patterns in the AR and CR groups at 1 month might reflect a clearer boundary between SMCs with contractile and synthetic features.…”