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Impact of optical coherence tomography‐derived neointimal tissue morphology on development of very late in‐stent restenosis
Author(s) -
Fujii Kenichi,
Otsuji Satoru,
Yamamoto Wataru,
Takiuchi Shin,
Ishibuchi Kasumi,
Tamaru Hiroto,
Kakishita Mikio,
Ibuki Motoaki,
Hasegawa Katsuyuki,
Ishii Rui,
Nakabayashi Sho,
Higashino Yorihiko
Publication year - 2020
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.28799
Subject(s) - neointima , medicine , restenosis , stent , neointimal hyperplasia , optical coherence tomography , thrombus , radiology , homogeneous , cardiology , physics , thermodynamics
Abstract Objectives This study evaluated the progression of very late in‐stent restenosis (VL‐ISR) by analyzing four serial coronary angiography (CAG) images and its correlation with neointimal tissue characterization of the VL‐ISR lesions on optical coherence tomography (OCT). Background Recently, VL‐ISR is occasionally observed beyond a few years after drug‐eluting stents (DESs) implantation. Methods This study analyzed 50 VL‐ISR lesions after DES in which 4 serial CAGs over a period of 2 years, including at baseline procedure, 9 months after baseline procedure, 12 months before VL‐ISR, and at the time of VL‐ISR, were performed. Neointimal tissue characteristics by OCT were categorized as homogeneous, heterogeneous with invisible strut (Type I), heterogeneous with visible strut (Type II), speckled (Type III), or heterogeneous with sharply delineated border (Type IV). Results From the development process, 23 VL‐ISRs (46%) were categorized as rapid progression and 27 (54%) as gradual progression. The five categories of neointimal tissue composition significantly differed between lesions with rapid and gradual progression. Homogeneous neointima and Type IV heterogeneous neointima were observed only in lesions with gradual progression. Moreover, most Type I heterogeneous neointima was identified in lesions with gradual progression. Instead, main neointimal tissue components of lesions with rapid progression were Type II (43%) and Type III (43%) heterogeneous neointima. Conclusion The progression rate of in‐stent atherosclerotic changes is gradual, whereas organized thrombus could be associated with an increased risk of rapid neointimal growth. The two types of stenosis progression provide a new insight into the mechanism of VL‐ISR development after DES implantation.