OCT-Nachweis einer Neoatherosklerose als Teil des fortlaufenden Prozesses der koronaren Herzkrankheit

Abstract

Although the advent of drug-eluting stents has reduced the rates of target vessel revascularization, there are observations of ongoing stent failure occurring very late after stent implantation and presenting as very late restenosis or as very late stent thrombosis. The de novo development of atherosclerosis within the neointimal region, called neoatherosclerosis, has been identified as one of the pathomechanisms of these observed late stent failures. The mechanisms of neoatherosclerosis development and its association with stent failure are currently the subject of intensive research. Optical coherence tomography (OCT) is an invasive imaging modality that allows us to visualize the micromorphology of coronary arteries with near-histological resolution, thus providing detailed assessment of the morphological characteristics of the neointima after stent implantation, including neoatherosclerosis. Several OCT studies have tried to provide in vivo insights in the mechanisms of neoatherosclerosis development and its association with late stent failure. This review summarizes the current insights into neoatherosclerosis obtained with OCT and discusses the association of neoatherosclerosis with late stent failure.

Optical Coherence Tomography For the Detection of the Vulnerable Plaque

“…[67][68][69][70][71] Neoatherosclerosis has been defined by pathological studies as the presence of clusters of lipid-laden foamy macrophages with or without necrotic core formation, and/or calcification within the neointimal tissue of stented segments. 68,72 Several OCT studies have demonstrated the association of neoatherosclerosis development with late stent failure. 72 The role of neointimal disruption, analogue to plaque rupture in native atherosclerosis, to very late stent thrombosis is under investigation.…”

“…68,72 Several OCT studies have demonstrated the association of neoatherosclerosis development with late stent failure. 72 The role of neointimal disruption, analogue to plaque rupture in native atherosclerosis, to very late stent thrombosis is under investigation. 64 Neointimal rupture has been shown to be a very prevalent mechanism in very late bare metal stent thrombosis, especially a long time after implantation, 73 and is one of the most common causes of late and very late drug-eluting stent thrombosis.…”

“…66,74 Neointimal rupture is a mechanism occurring mainly at longer intervals following stent implantation, 75 in regions with high necrotic core content and thin fibrous cap 76 (similarly to what is observed with vulnerable plaques in native atherosclerosis) and a high incidence of macrophage infiltration. 76 These features are being identified mainly by OCT. 72…”

Very Late In-stent Restenosis due to Neoatherosclerosis in the Second-generation Everolimus-eluting Stent

“…15) Although angiographic late loss or restenosis reduced in the second-generation DES, 16) intracoronary imaging such as OCT and CAS disclosed the participation of neoatherosclerosis associated with catastrophic stent thrombosis. 17) A basic study showed neoathersclerosis occurs rapidly in DES might be due to the eluted drug prevents endothelial cell proliferation and viability, migration which allows infiltration of lipid-laden foamy macrophage into the vessel accelerating atherosclerotic change. [18][19][20][21] According to human autopsy, neoatherosclerosis can arise in the second-generation DES.…”

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

“…Optical coherence tomography (OCT) is a light‐base imaging modality with unprecedented resolution, which enables in vivo assessment of coronary plaque microstructure, such as thin‐cap fibroatheroma, thrombus, macrophage accumulation, micro‐vessel, and cholesterol crystals . Besides, OCT can effectively identify different patterns of neointimal hyperplasia as well as neoatherosclerosis, which shows a good correlation to historic findings . OCT‐based heterogeneous neointimal tissue without feature of neoatherosclerosis is also thought to be linked to poor long‐term clinical prognosis .…”