Effect of neointimal tissue morphology on vascular response to balloon angioplasty in lesions with in-stent restenosis after drug-eluting stent deployment: an optical coherence tomography analysis

Yamamoto, Wataru; Fujii, Kenichi; Otsuji, Satoru; Takiuchi, Shin; Kakishita, Mikio; Sakai, Yuji; Hasegawa, Katsuyuki; Ishibuchi, Kasumi; Ishii, Rui; Yasuda, Shingo; Taniguchi, Yusuke; Nakabayashi, Sho; Kusumoto, Hirofumi; Higashino, Yorihiko

doi:10.1007/s00380-020-01595-z

Cited by 4 publications

(2 citation statements)

References 21 publications

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“…For these reasons, Yamamoto et al suggested modifying the OCT-guided ISR classification as follows: homogeneous high-intensity tissue (type I), heterogeneous tissue with signal attenuation (type II), heterogeneous speckled tissue (type III), mixed tissue containing poorly delineated region with an invisible strut (type IV), mixed tissue containing sharply delineated low-intensity region (type V) and bright protruding tissue with an irregular surface (type VI). Additionally, the potential clinical significance of this classification has been further explored; the authors found that the incidence of stent fracture was significantly higher in both type I and IV, whereas the duration between stent implantation and ISR resulted significantly longer in types IV and VI [ 50 ].…”

Section: In-stent Restenosis and Neo-atherosclerosis: The Pivotal Rol...mentioning

confidence: 99%

In Stent Neo-Atherosclerosis: Pathophysiology, Clinical Implications, Prevention, and Therapeutic Approaches

Nusca

Viscusi

Piccirillo

et al. 2022

Life

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Despite the dramatic improvements of revascularization therapies occurring in the past decades, a relevant percentage of patients treated with percutaneous coronary intervention (PCI) still develops stent failure due to neo-atherosclerosis (NA). This histopathological phenomenon following stent implantation represents the substrate for late in-stent restenosis (ISR) and late stent thrombosis (ST), with a significant impact on patient’s long-term clinical outcomes. This appears even more remarkable in the setting of drug-eluting stent implantation, where the substantial delay in vascular healing because of the released anti-proliferative agents might increase the occurrence of this complication. Since the underlying pathophysiological mechanisms of NA diverge from native atherosclerosis and early ISR, intra-coronary imaging techniques are crucial for its early detection, providing a proper in vivo assessment of both neo-intimal plaque composition and peri-strut structures. Furthermore, different strategies for NA prevention and treatment have been proposed, including tailored pharmacological therapies as well as specific invasive tools. Considering the increasing population undergoing PCI with drug-eluting stents (DES), this review aims to provide an updated overview of the most recent evidence regarding NA, discussing pathophysiology, contemporary intravascular imaging techniques, and well-established and experimental invasive and pharmacological treatment strategies.

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Section: In-stent Restenosis and Neo-atherosclerosis: The Pivotal Rol...mentioning

confidence: 99%

In Stent Neo-Atherosclerosis: Pathophysiology, Clinical Implications, Prevention, and Therapeutic Approaches

Nusca

Viscusi

Piccirillo

et al. 2022

Life

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show abstract

“…In the present study, we used a novel OCT/OFDI classification of in‐stent neointima that aimed to classify most ISR lesions easily and certainly with a higher degree of reproducibility based on the previous studies. 10 , 18 To reflect histological substrates, in‐stent neointima tissue characteristics were classified into 4 groups as follows: (1) homogeneous neointima pattern; (2) heterogeneous neointima with layered pattern; (3) heterogeneous neointima without layered pattern; and (4) neoatherosclerosis pattern (Figure 1 and Data S1 ). The criteria for the diagnosis of neoatherosclerosis were lesion with lipid neointima.…”

Section: Methodsmentioning

confidence: 99%

Relationship Between Optical Coherence Tomography–Derived In‐Stent Neoatherosclerosis and the Extent of Lipid‐Rich Neointima by Near‐Infrared Spectroscopy and Intravascular Ultrasound: A Multimodal Imaging Study

Takeuchi

Dohi

Matsumura

et al. 2022

JAHA

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Background In‐stent restenosis, especially for neoatherosclerosis, is a major concern following percutaneous coronary intervention. This study aimed to elucidate the association of features of in‐stent restenosis lesions revealed by optical coherence tomography (OCT)/optical frequency domain imaging (OFDI) and the extent of lipid‐rich neointima (LRN) assessed by near‐infrared spectroscopy (NIRS) and intravascular ultrasound, especially for neoatherosclerosis. Methods and Results We analyzed patients undergoing percutaneous coronary intervention for in‐stent restenosis lesions using both OCT/OFDI and NIRS–intravascular ultrasound. OCT/OFDI‐derived neoatherosclerosis was defined as lipid neointima. The existence of large LRN (defined as a long segment with 4‐mm maximum lipid core burden index ≥400) was evaluated by NIRS. In 59 patients with 64 lesions, neoatherosclerosis and large LRN were observed in 17 (26.6%) and 21 lesions (32.8%), respectively. Naturally, large LRN showed higher 4‐mm maximum lipid core burden index (median [interquartile range], 623 [518–805] versus 176 [0–524]; P <0.001). In OCT/OFDI findings, large LRN displayed lower minimal lumen area (0.9±0.4 versus 1.3±0.6 mm 2 ; P =0.02) and greater max lipid arc (median [interquartile range], 272° [220°–360°] versus 193° [132°–247°]; P =0.004). In the receiver operating characteristic curve analysis, 4‐mm maximum lipid core burden index was the best predictor for neoatherosclerosis, with a cutoff value of 405 (area under curve, 0.92 [95% CI, 0.83–1.00]). In multivariable logistic analysis, only low‐density lipoprotein cholesterol (odds ratio, 1.52 [95% CI, 1.11–2.08]) was an independent predictor for large LRNs. Conclusions NIRS‐derived large LRN was significantly associated with neoatherosclerosis by OCT/OFDI. The neointimal characterization by NIRS–intravascular ultrasound has potential as an alternative method of OCT/OFDI for in‐stent restenosis lesions.

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Diagnostic accuracy of optical coherence tomography for the identification of in-stent fibroatheroma following stent implantation: an ex vivo histological validation study

Shibutani

Fujii

Kawakami

et al. 2021

Int J Cardiovasc Imaging

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Effect of neointimal tissue morphology on vascular response to balloon angioplasty in lesions with in-stent restenosis after drug-eluting stent deployment: an optical coherence tomography analysis

Cited by 4 publications

References 21 publications

In Stent Neo-Atherosclerosis: Pathophysiology, Clinical Implications, Prevention, and Therapeutic Approaches

In Stent Neo-Atherosclerosis: Pathophysiology, Clinical Implications, Prevention, and Therapeutic Approaches

Relationship Between Optical Coherence Tomography–Derived In‐Stent Neoatherosclerosis and the Extent of Lipid‐Rich Neointima by Near‐Infrared Spectroscopy and Intravascular Ultrasound: A Multimodal Imaging Study

Diagnostic accuracy of optical coherence tomography for the identification of in-stent fibroatheroma following stent implantation: an ex vivo histological validation study

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