In-Stent Yellow Plaque at 1 Year After Implantation Is Associated With Future Event of Very Late Stent Failure

Ueda, Yasunori; Matsuo, Koshi; Nishimoto, Yuji; Sugihara, Ryuta; Hirata, Akio; Nemoto, Takayoshi; Okada, Masato; Murakami, Aki; Kashiwase, Kazunori; Kodama, Kazuhisa

doi:10.1016/j.jcin.2014.12.239

Cited by 79 publications

(17 citation statements)

References 33 publications

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“…A recent prospective study has demonstrated that yellow plaque at the lesion previously treated with DES predicts future late stent failure. 20 Hypertension was negatively associated with thrombus, which was an unexpected finding, because most of the previous studies reported no association between hypertension and stent thrombosis. However, it is noteworthy that use of 1st-DES had the strongest association with thrombus.…”

Section: Discussionmentioning

confidence: 80%

Comparison of Chronic Angioscopic Findings of Bare Metal Stents, 1st-Generation Drug-Eluting Stents and 2nd-Generation Drug-Eluting Stents　– Multicenter Study of Intra-Coronary Angioscopy After Stent (MICASA) –

Dai

Matsuoka

Kawakami

et al. 2016

Circ J

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1916DAI K et al. Circulation JournalOfficial Journal of the Japanese Circulation Society http://www. j-circ.or.jp Editorial p 1895Coronary angioscopy permits direct visualization of the intracoronary structure. It has been demonstrated that coronary angioscopy is a useful tool for estimating the neointimal coverage (NC) of stent struts, not only quantitatively by showing the coverage grade but also qualitatively by showing the plaque's yellow color (YC) grade. Several studies have compared the angioscopic findings of 2 specific types of stent, but no previous study has reported a comprehensive comparison of the he drug-eluting stent (DES) has dramatically reduced the risk of restenosis and target vessel revascularization as compared with bare metal stents (BMS). 1-3 Because the 1st-generation DES (1st-DES) was used widely around the world, concern was raised of an increased risk of late stent thrombosis after 1st-DES implantation. 4,5 The 2nd-generation DES (2nd-DES) has been designed with the goal of improving safety, efficacy, and device performance. Several clinical studies have demonstrated that 2nd-DES are associated with favorable clinical outcomes, including lower incidence of very late stent thrombosis, than 1st-DES. Background: No previous study has reported a comprehensive comparison of the chronic angioscopic findings after bare metal stent (BMS), and 1st-and 2nd-generation drug-eluting stents (DES).

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Section: Discussionmentioning

confidence: 80%

Comparison of Chronic Angioscopic Findings of Bare Metal Stents, 1st-Generation Drug-Eluting Stents and 2nd-Generation Drug-Eluting Stents　– Multicenter Study of Intra-Coronary Angioscopy After Stent (MICASA) –

Dai

Matsuoka

Kawakami

et al. 2016

Circ J

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“…Yellow plaque, thrombosis and endothelial dysfunction are known to be particularly prevalent in the first generation DES, and such delayed arterial healing is considered to be associated with inflammation [21]. Furthermore, it has been reported that yellow plaque observed after DES placement is associated with subsequent cardiac events, and the underlying mechanism is presumed to be the development of arteriosclerosis [22].…”

Section: Yellow Plaque Thrombus and Erosion-like Intima (Eli)mentioning

confidence: 99%

Different vascular healing process between bioabsorbable polymer-coated everolimus-eluting stents versus bioresorbable vascular scaffolds via optical coherence tomography and coronary angioscopy (the ENHANCE study: ENdothelial Healing Assessment with Novel Coronary tEchnology)

et al. 2019

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Recent clinical trials have raised concerns about the safety and efficacy of ABSORB™ bioresorbable vascular scaffolds (BVS). The difference in the vascular healing process between SYNERGY™ bioabsorbable polymer-coated everolimus-eluting stents (BP-EES) and BVS remains unclear. The aim of the ENHANCE study was to compare vascular healing on BP-EES versus BVS by optical coherence tomography (OCT) and coronary angioscopy (CAS) at 4-and 12-month follow-ups. This is a prospective, non-randomized, single center clinical trial. Thirteen eligible patients with multivessel disease were enrolled. BP-EES and BVS were simultaneously implanted in the same patients, but in different coronary vessels. Imaging follow-up with both OCT and CAS was completed in 11 patients at 12 months. Neointimal coverage rates were similar between the two groups based on OCT measurements. The neointimal thickness of BP-EES was significantly thicker at the 12th month than at the 4th month, whereas the neointimal thickness of BVS did not change between the measurements taken at the 4th and 12th month. Existence of intra-stent thrombus was significantly higher in the BVS group, compared to the BP-EES group. On the other hand, CAS revealed that red-thrombi and yellow-plaque were more frequently observed in BVS at 4 months and up to 12-month follow-ups than in BP-EES. These findings suggested that the evidence of instability remained up to 12 months in the vascular healing with BVS, compared to that with BP-EES. Vascular healing of the stented wall was recognized at the very early phase after BP-EES implantation. However, vascular healing with BVS was still incomplete after 12 months.

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“…9 A prospective study has shown that yellow plaque at the DES-implanted lesion predicts late stent-related events. 10 Thus, CAS has been used to compare vascular responses to different types of coronary stent. 11 Such ability to visualize plaque color is one of the greatest advantages of CAS over other intravascular imaging techniques.…”

Section: Editorialmentioning

confidence: 99%

Coronary Angioscopy for the Evaluation of Vessel Response After Drug-Eluting Stent Implantation

Shibuya

Ishihara

2016

Circ J

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Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp than BMS. Recently, a new-generation ZES, the Resolute ZES (R-ZES), which has slower drug release kinetics, became available. Despite using the same platform and drug, clinical outcomes are different between E-ZES and R-ZES. In this issue of the Journal, Nishimoto et al performed coronary angioscopy (CAS) 1 year after R-ZES and E-ZES implantation and reported that E-ZES had better neointimal coverage with less yellow plaque and a lower heterogeneity score than R-ZES. 7 These findings may explain the more stable longterm clinical outcomes of lesions treated with E-ZES. Article p 650CAS allows direct visualization of the color and superficial morphology of the plaque and thrombus, using projected white light through thin, flexible glass fibers loaded into catheters. Several studies have shown that CAS can identify atherosclerosis as a yellow color, which has been regarded as high-risk plaques correlated with future coronary events. 8 CAS has also been used to evaluate the vascular response to stent implantation. Serial CAS examinations have revealed that white neointima at the DES-implanted lesion rapidly becomes yellow. This phenomenon is pathologically confirmed as neoatherosclerosis after DES. Thrombus are frequently found at the site of yellow plaque, especially when neointimal coverage over rug-eluting stents (DES) have been widely used because they dramatically reduce the occurrence of restenosis and target lesion revascularization. However, late stent thrombosis has emerged as a major concern, because of excessive inhibition of neointimal formation and delayed arterial healing with insufficient endothelialization. 1 Therefore, prolonged dual antiplatelet therapy (DAPT) is recommended after DES implantation. Second-generation DES have been designed to overcome the safety issues of the 1st-generation DES by using thinner stent strut and polymers with different properties. 2 The Endeavor zotarolimus-eluting stent (E-ZES) is a cobalt chromium-based thin-strut stent that has a phosphorylcholine biocompatible polymer with shorter drug-eluting duration. 3 Clinical investigation has shown that the E-ZES had nearly complete neointimal coverage at 3 months. 4 Sufficient arterial repair characterized by less development of thrombus, and substantial neointima formation occurred by 4 months after E-ZES implantation. 5 Such more rapid arterial repair than with other DES may contribute to neointimal stability. The ZEUS (Zotarolimus-eluting Endeavor sprint stent in Uncertain DES candidates) trial randomized uncertain DES candidates (high bleeding risk, high thrombotic risk or low restenosis risk) to receive E-ZES or bare metal stent (BMS). 6 Despite short DAPT duration (median 32 days), E-ZES was associated with lower 1-year major adverse cardiac events DThe opinions expressed in this article are not necessarily those of the editors or of the Japanese Circulation Society.

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In-Stent Yellow Plaque at 1 Year After Implantation Is Associated With Future Event of Very Late Stent Failure

Abstract: In-stent atherosclerosis evaluated by yellow plaque at 1 year after the implantation of DES and the absence of statin therapy were risks of VLSF. The underlying mechanism of VLSF appeared to be the progression of atherosclerosis as demonstrated by the yellow plaque.

Cited by 79 publications

References 33 publications

Comparison of Chronic Angioscopic Findings of Bare Metal Stents, 1st-Generation Drug-Eluting Stents and 2nd-Generation Drug-Eluting Stents　– Multicenter Study of Intra-Coronary Angioscopy After Stent (MICASA) –

Comparison of Chronic Angioscopic Findings of Bare Metal Stents, 1st-Generation Drug-Eluting Stents and 2nd-Generation Drug-Eluting Stents　– Multicenter Study of Intra-Coronary Angioscopy After Stent (MICASA) –

Different vascular healing process between bioabsorbable polymer-coated everolimus-eluting stents versus bioresorbable vascular scaffolds via optical coherence tomography and coronary angioscopy (the ENHANCE study: ENdothelial Healing Assessment with Novel Coronary tEchnology)

Coronary Angioscopy for the Evaluation of Vessel Response After Drug-Eluting Stent Implantation

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In-Stent Yellow Plaque at 1 Year After Implantation Is Associated With Future Event of Very Late Stent Failure

Abstract: In-stent atherosclerosis evaluated by yellow plaque at 1 year after the implantation of DES and the absence of statin therapy were risks of VLSF. The underlying mechanism of VLSF appeared to be the progression of atherosclerosis as demonstrated by the yellow plaque.

Cited by 79 publications

References 33 publications

Comparison of Chronic Angioscopic Findings of Bare Metal Stents, 1st-Generation Drug-Eluting Stents and 2nd-Generation Drug-Eluting Stents – Multicenter Study of Intra-Coronary Angioscopy After Stent (MICASA) –

Comparison of Chronic Angioscopic Findings of Bare Metal Stents, 1st-Generation Drug-Eluting Stents and 2nd-Generation Drug-Eluting Stents – Multicenter Study of Intra-Coronary Angioscopy After Stent (MICASA) –

Different vascular healing process between bioabsorbable polymer-coated everolimus-eluting stents versus bioresorbable vascular scaffolds via optical coherence tomography and coronary angioscopy (the ENHANCE study: ENdothelial Healing Assessment with Novel Coronary tEchnology)

Coronary Angioscopy for the Evaluation of Vessel Response After Drug-Eluting Stent Implantation

Contact Info

Product

Resources

About

Comparison of Chronic Angioscopic Findings of Bare Metal Stents, 1st-Generation Drug-Eluting Stents and 2nd-Generation Drug-Eluting Stents　– Multicenter Study of Intra-Coronary Angioscopy After Stent (MICASA) –

Comparison of Chronic Angioscopic Findings of Bare Metal Stents, 1st-Generation Drug-Eluting Stents and 2nd-Generation Drug-Eluting Stents　– Multicenter Study of Intra-Coronary Angioscopy After Stent (MICASA) –