Neoatherosclerosis in Patients With Coronary Stent Thrombosis

Joner, Michael; Koppara, Tobias; Byrne, Robert A.; Castellanos, Maria Isabel; Lewerich, J.; Novotny, Julia; Guagliumi, Giulio; Xhepa, Erion; Adriaenssens, Tom; Godschalk, Thea C.; Malik, Nikesh; Alfonso, Fernándo; Tada, Takeshi; Neumann, Franz‐Josef; Desmet, Walter; Berg, Jürrien M. ten; Gershlick, Anthony; Feldman, Laurent J.; Maßberg, Steffen; Kastrati, Adnan

doi:10.1016/j.jcin.2018.02.029

Cited by 40 publications

(14 citation statements)

References 16 publications

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“… 5 , 18 Recently, with the progression of intravascular imaging technology, infiltration of macrophages was also identified by optical coherence tomography in plaques within the stents of patients with VLST. 6 …”

Section: Discussionmentioning

confidence: 99%

“…4 In a large-scale study of histological thrombus analysis on patients presenting with stent thrombosis, the recruitment of leukocytes, particularly of neutrophils and eosinophils, was found to be the hallmark of stent thrombosis when compared with a control group with spontaneous AMI treated by thrombus aspiration. 5 Correspondently, recent optical coherence tomography data from patients with VLST found increased macrophage infiltration in neoatherosclerosis within the stent, 6 which indicates the role of inflammation in the development of VLST. S100A8/A9, also known as myeloid-related protein 8/14, has been found to play a decisive role in modulating the inflammatory response by stimulating leukocyte recruitment and inducing cytokine secretion.…”

Section: Introductionmentioning

confidence: 98%

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The Association Between S100A8/A9 and the Development of Very Late Stent Thrombosis in Patients With Acute Myocardial Infarction

Wang

Guan

Zhang

et al. 2020

Clin Appl Thromb Hemost

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Very late stent thrombosis (VLST) is a rare but serious complication following percutaneous coronary intervention (PCI). S100A8/A9 plays an important role in thrombosis through modulating the inflammatory response. This observational study aimed to reveal the association between S100A8/A9 and VLST. Continuous blood samples were collected from patients at both the time of index PCI for acute myocardial infarction (AMI) and the time of PCI for VLST (VLST group) or follow-up coronary angiography (AMI group). In all, 56 patients were selected in each group from a cohort of 8476 patients and other 112 individuals who underwent health checkups (normal control [NC] group) were selected as controls. Serum levels of S100A8/A9 and high sensitivity C-reactive protein (hs-CRP) were tested and compared. The mean level of S100A8/A9 was 3754.4 ± 1688.9 ng/mL during index PCI and increased to 5517.8 ± 2650.9 ng/mL at the time of VLST; in the AMI group, S100A8/A9 level was 2434.9 ± 1243.4 ng/mL during index PCI and decreased to 1568.2 ± 772.1 ng/mL during follow-up, similar to that detected in the NC group (1618.2 ± 641.4 ng/mL). Of note, S100A8/A9 levels showed significant increases during VLST when compared to its own levels during index PCI, which was different from the changes of hs-CRP. Higher serum levels of S100A8/A9 are associated with the development of VLST.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 98%

The Association Between S100A8/A9 and the Development of Very Late Stent Thrombosis in Patients With Acute Myocardial Infarction

Wang

Guan

Zhang

et al. 2020

Clin Appl Thromb Hemost

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“…Therefore, the mechanisms that impair vascular healing are increasingly investigated to explain disease progression and the development of ACS (22)(23)(24). Following stent implantation, vascular healing and tissue response play a similar decisive role in defining the risk of stent failure and future complications (25)(26)(27)(28). Thus, there is an urgent need for imaging methods that afford refined insight into a lesion's make-up, composition, and healing, in order to address pertinent questions regarding the pathophysiology of atherosclerosis and to ultimately improve the risk stratification and management of patients with coronary artery disease.…”

Section: Introductionmentioning

confidence: 99%

Intravascular Polarimetry: Clinical Translation and Future Applications of Catheter-Based Polarization Sensitive Optical Frequency Domain Imaging

Otsuka

Villiger

Nadkarni

et al. 2020

Front. Cardiovasc. Med.

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Optical coherence tomography (OCT) and optical frequency domain imaging (OFDI) visualize the coronary artery wall and plaque morphology in great detail. The advent of these high-resolution intracoronary imaging modalities has propelled our understanding of coronary atherosclerosis and provided enhanced guidance for percutaneous coronary intervention. Yet, the lack of contrast between distinct tissue types and plaque compositions impedes further elucidation of the complex mechanisms that contribute to acute coronary syndrome (ACS) and hinders the prospective identification of plaques susceptible to rupture. Intravascular polarimetry with polarization-sensitive OFDI measures polarization properties of the coronary arterial wall using conventional intravascular imaging catheters. The quantitative polarization metrics display notable image contrast between several relevant coronary plaque microstructures that are difficult to identify with conventional OCT and OFDI. Tissues rich in collagen and smooth muscle cells exhibit birefringence, while lipid and macrophages cause depolarization. In this review, we describe the basic principles of intravascular polarimetry, discuss the interpretation of the polarization signatures, and outline promising avenues for future research and clinical implications.

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“…These can progress to form fibroatheroma and develop necrotic cores containing acellular debris and free cholesterol. Lately, neoatherosclerosis with rupture of thin-cap fibroatheroma (TCFA) has been recognized as the predominant cause in patients presenting with very late stent thrombosis [9], where foamy macrophage infiltration of the fibrous cap was identified as important surrogate of neointimal plaque vulnerability [10]. Neointimal foamy macrophages cause a characteristic imaging pattern during intravascular imaging with OCT [11,12].…”

Section: Introductionmentioning

confidence: 99%

“…In a large registry investigating very-late stent thrombosis, neointimal plaque rupture was observed as the underlying aetiology in 31.3% of patients [9]. Infiltration with neointimal foamy macrophages was significantly higher in ruptured compared to stable plaques [10] and may consequently serve as surrogate for plaque vulnerability in the setting of neoatherosclerosis.…”

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confidence: 99%

Validation and application of OCT tissue attenuation index for the detection of neointimal foam cells

Nicol

Hoppman

Euller

et al. 2020

Int J Cardiovasc Imaging

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Neointimal infiltration with foamy macrophages is recognized as an early and important sign of de-novo atherosclerosis after stent implantation (neoatherosclerosis). Recent histopathological studies have proven that automated quantification of signal attenuation using intravascular optical coherence tomography (OCT) imaging allows for sensitive identification of macrophages in native atherosclerotic disease. Whether this is true for neointimal foam cells in the setting of neoatherosclerosis remains unknown. Autopsy samples of stented coronary arteries (n = 13 cases) were evaluated by histology and OCT. After co-registration with histology, the attenuation rate of emitted laser light was measured in regions with and without neointimal foamy macrophages relative to its peak intensity at the blood-tissue interface. Attenuation index was subsequently determined as slope of a regression curve fitted to individual data points. Receiver operating curve (ROC) analysis was used to establish an optimal cutoff for detecting foamy macrophages in homogenous and non-homogenous neointima, respectively. Finally, the tissue attenuation index was applied to confirm or exclude the presence of neointimal foamy macrophages in symptomatic patients presenting with in-stent restenosis and undergoing intravascular OCT imaging (n = 29 cases). Tissue attenuation index derived from post-mortem samples differed significantly between histologically confirmed regions with and without neointimal foamy macrophages (− 1.23 ± 1.42 vs. − 0.52 ± 1.79, p < 0.05). ROC analysis was able to distinguish neointima with foamy macrophage infiltration from neointima without (93% sensitivity, 73% specificity, cutoff − 0.79, AUC 0.87 for homogenous neointima and 40% sensitivity, 95% specificity, cutoff − 1.93, AUC 0.69 for non-homogenous neointima). In symptomatic patients presenting with in-stent restenosis after stent implantation and undergoing intravascular imaging with OCT, neointimal foamy macrophages were detected in 34.2% of homogenous and 43.6% of non-homogenous neointimal ROI's evaluated. OCT-derived and histopathologically validated tissue attenuation index enables identification of neointimal foamy macrophages in stented coronary arteries. Such image-based post-processing software algorithm may help discern and triage subjects at increased risk for device-related events.

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Neoatherosclerosis in Patients With Coronary Stent Thrombosis

Cited by 40 publications

References 16 publications

The Association Between S100A8/A9 and the Development of Very Late Stent Thrombosis in Patients With Acute Myocardial Infarction

The Association Between S100A8/A9 and the Development of Very Late Stent Thrombosis in Patients With Acute Myocardial Infarction

Intravascular Polarimetry: Clinical Translation and Future Applications of Catheter-Based Polarization Sensitive Optical Frequency Domain Imaging

Validation and application of OCT tissue attenuation index for the detection of neointimal foam cells

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