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Neointima and neoatherosclerotic characteristics in bare metal and first and second generation drug eluting stents in patients admitted with cardiovascular events attributed to stent failure: an optical coherence tomography study


Stettler, Rodrigue; Dijkstra, Jouke; Räber, Lorenz; Torii, Ryo; Zhang, Yao-Jun; Karanasos, Antonis; Liu, Shengnan; Crake, Tom; Hamshere, Steve; Garcia-Garcia, Hector M; Tenekecioglu, Erhan; Ozkor, Muhiddin; Windecker, Stephan; Serruys, Patrick W; Regar, Evelyn; Mathur, Anthony; Bourantas, Christos V (2017). Neointima and neoatherosclerotic characteristics in bare metal and first and second generation drug eluting stents in patients admitted with cardiovascular events attributed to stent failure: an optical coherence tomography study. EuroIntervention:Epub ahead of print.

Abstract

AIMS: To assess neoatherosclerotic plaque morphology in bare metal (BMS) and 1st and 2nd generation drug eluting stents (DES) in patients presenting with an event attributed to stent failure.
METHODS AND RESULTS: Thirty five patients (11 implanted with BMS, 13 with a 1st generation and 11 with a 2nd generation DES) admitted with an event due to stent failure who had neoatherosclerotic lesions on optical coherence tomography were included in the analysis. The lumen and stent borders were detected and the lipid and calcific tissue were identified in the neointima and their burden was estimated. The neointima attenuation and backscatter indices were computed and compared between different stent types. Although there were no differences in the neointima burden, the BMS group exhibited thinner fibrous caps (P<0.001), and numerically increased incidence of lipid-rich plaques (P=0.052) and macrophage accumulation (P=0.012). Neointima discontinuities (P=0.009) and thrombus (P=0.032) were seen more often in 1st generation DES. In all stent types neoatherosclerosis had focal manifestations. In neoatherosclerotic lesions the attenuation and backscatter indices were increased in BMS (P=0.031 and P=0.018 respectively) compared to DES; however, there were no differences between stents in the attenuation indices in sub-segments located distally to neoatherosclerotic lesions which had low values in all stent types.
CONCLUSIONS: Although there are differences in lipid burden and neointima characteristics in different stent types, in all stents neoatherosclerosis has focal manifestations indicating that irrespective of the stent type focal triggers are involved in the generation of vulnerable neo-lesions.

Abstract

AIMS: To assess neoatherosclerotic plaque morphology in bare metal (BMS) and 1st and 2nd generation drug eluting stents (DES) in patients presenting with an event attributed to stent failure.
METHODS AND RESULTS: Thirty five patients (11 implanted with BMS, 13 with a 1st generation and 11 with a 2nd generation DES) admitted with an event due to stent failure who had neoatherosclerotic lesions on optical coherence tomography were included in the analysis. The lumen and stent borders were detected and the lipid and calcific tissue were identified in the neointima and their burden was estimated. The neointima attenuation and backscatter indices were computed and compared between different stent types. Although there were no differences in the neointima burden, the BMS group exhibited thinner fibrous caps (P<0.001), and numerically increased incidence of lipid-rich plaques (P=0.052) and macrophage accumulation (P=0.012). Neointima discontinuities (P=0.009) and thrombus (P=0.032) were seen more often in 1st generation DES. In all stent types neoatherosclerosis had focal manifestations. In neoatherosclerotic lesions the attenuation and backscatter indices were increased in BMS (P=0.031 and P=0.018 respectively) compared to DES; however, there were no differences between stents in the attenuation indices in sub-segments located distally to neoatherosclerotic lesions which had low values in all stent types.
CONCLUSIONS: Although there are differences in lipid burden and neointima characteristics in different stent types, in all stents neoatherosclerosis has focal manifestations indicating that irrespective of the stent type focal triggers are involved in the generation of vulnerable neo-lesions.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Cardiovascular Surgery
Dewey Decimal Classification:610 Medicine & health
Uncontrolled Keywords:In-stent resenosis, Bare metal stent, Drug-eluting stent, Optical coherence tomography
Language:English
Date:13 June 2017
Deposited On:19 Dec 2017 16:48
Last Modified:19 Dec 2017 16:48
Publisher:Europa Digital and Publishing
ISSN:1774-024X
Free access at:Publisher DOI. An embargo period may apply.
Publisher DOI:https://doi.org/10.4244/EIJ-D-17-00051
PubMed ID:28606888

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