Relationship between residual atheroma burden and neointimal growth in patients undergoing stenting

Casserly, Ivan P.; Aronow, Herbert D.; Schoenhagen, Paul; Tsutsui, Hiroshi; Popovich, Jennifer; Goormastic, Marlene; Popma, Jeffrey J.; Nissen, Steven E.; Tuzcu, E. Murat

doi:10.1016/s0735-1097(02)02341-0

Cited by 14 publications

(1 citation statement)

References 17 publications

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“…These intriguing observations raised the possibility that the bulk of the intimal proliferation may be occurring at the original site of the lesion and led to an initial enthusiasm for plaque removal by adjunctive atherectomy before BMS implantation with results pointing to a reduction in the incidence of in-stent restenosis [11]. Nevertheless, the role of PBS remained controversial, as there were also studies reporting no association between post-BMS placement PBS and neointimal tissue growth [4, 12]. On the other hand, IVUS analyses in the DES era supported the notion that late in-stent neointimal proliferation is not related to the amount of residual PBS after DES implantation [5].…”

Section: Discussionmentioning

confidence: 99%

Atherosclerotic plaque behind the stent changes after bare-metal and drug-eluting stent implantation in humans: Implications for late stent failure?

et al. 2016

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Background and aims The natural history and the role of atherosclerotic plaque located behind the stent (PBS) are still poorly understood. We evaluated the serial changes in PBS following bare-metal (BMS) compared to first-generation drug-eluting stent (DES) implantation and the impact of these changes on in-stent neointimal hyperplasia (NIH). Methods Three-dimensional coronary reconstruction by angiography and intravascular ultrasound was performed after intervention and at 6–10-month follow-up in 157 patients with 188 lesions treated with BMS (n=89) and DES (n=99). Results There was a significant decrease in PBS area (−7.2%; p<0.001) and vessel area (−1.7%; p<0.001) after BMS and a respective increase in both areas after DES implantation (6.1%; p<0.001 and 4.1%; p<0.001, respectively). The decrease in PBS area significantly predicted neointimal area at follow-up after BMS (β: 0.15; 95% confidence interval [CI]: 0.10–0.20, p<0.001) and DES (β: 0.09; 95% CI: 0.07–0.11; p<0.001) implantation. The decrease in PBS area was the most powerful predictor of significant NIH after BMS implantation (odds ratio: 1.13; 95% CI: 1.02–1.26; p=0.02). Conclusions The decrease in PBS area after stent implantation is significantly associated with the magnitude of NIH development at follow-up. This finding raises the possibility of a communication between the lesion within the stent and the underlying native atherosclerotic plaque, and may have important implications regarding the pathobiology of in-stent restenosis and late/very late stent thrombosis.

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Section: Discussionmentioning

confidence: 99%

Atherosclerotic plaque behind the stent changes after bare-metal and drug-eluting stent implantation in humans: Implications for late stent failure?

et al. 2016

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Early experience with a novel plaque excision system for the treatment of complex coronary lesions

Ikeno

Hinohara

Robertson

et al. 2003

Cathet Cardio Intervent

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The use of directional coronary atherectomy (DCA) in current practice has been limited. The SilverHawk System is a newly developed plaque excision device that aims to overcome the drawbacks of prior DCA platforms. The device was evaluated in a porcine coronary model and in a series of patients. Procedural variables along with outcomes were reviewed. Quantitative angiography (QCA) was performed and excised tissue fragments were weighed and examined histologically. In porcine cases, pretreatment MLD increased from 0.51 +/- 0.26 to 2.36 +/- 0.59 mm postdebulking and 19.9 +/- 7.6 mg of tissue was retrieved. In human cases, pretreatment MLD increased from 0.8 +/- 0.4 to 2.2 +/- 0.5 mm postdebulking and 15.2 +/- 7.8 mg of tissue was retrieved without complications. These data show that the SilverHawk System may offer significant utility in treating a wide variety of complex coronary lesions.

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What do cardiologists want from vascular ultrasound?

Kaneda

Honda

Yock

et al. 2003

Vascular Ultrasound

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Relationship between residual atheroma burden and neointimal growth in patients undergoing stenting

Abstract: This study failed to demonstrate a clinically significant relationship between quantitative volumetric and cross-sectional measures of residual atheroma burden and subsequent neointimal growth.

Cited by 14 publications

References 17 publications

Atherosclerotic plaque behind the stent changes after bare-metal and drug-eluting stent implantation in humans: Implications for late stent failure?

Atherosclerotic plaque behind the stent changes after bare-metal and drug-eluting stent implantation in humans: Implications for late stent failure?

Early experience with a novel plaque excision system for the treatment of complex coronary lesions

What do cardiologists want from vascular ultrasound?

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