Emerging evidence suggests that neointimal degenerative changes with development of
neoatherosclerosis (NA) may represent an important mechanism for late stent failure.
The aim of the present study was to investigate the relation between degree of neointimal
hyperplasia and incidence and characteristics of NA using optical coherence tomography.
We identified a total of 252 stents with mean neointimal thickness (NIT) >100 μm in
212 patients: 100 bare metal stents (BMSs) and 152 drug-eluting stents (DESs). Based
on the values of mean NIT, we divided stents into tertiles and compared neointimal
characteristics among the 3 groups. NA was defined as the presence of lipid-laden
intima and/or calcification inside the stent. In both BMS and DES, there was a difference
in the prevalence of lipid-laden intima among the tertiles (18.2% vs 36.4% vs 47.1%,
p = 0.042 [BMS]; 19.6% vs 56.9% vs 88.0%, p <0.001 [DES]). However, no difference
in the prevalence of in-stent calcification was observed (21.2% vs 21.2% vs 2.9%,
p = 0.053 [BMS]; 5.9% vs 9.8% vs 2.0%, p = 0.252 [DES]). In a multivariate model adjusting
for stent type, follow-up duration, conventional coronary risk factors, statin, and
angiotensin-converting enzyme inhibitor or angiotensin II receptor blockade use, mean
NIT was independently associated with the presence of NA (odds ratio 2.53, 95% confidence
interval 1.96 to 3.27, p <0.001). This study demonstrates the presence of a positive
correlation between degree of neointimal hyperplasia after stent implantation and
presence of lipid-laden intima. This association is independent from stent type and
time from implantation and suggests a possible pathogenic link between the two processes.
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Article Info
Publication History
Published online: July 29, 2013
Accepted:
May 31,
2013
Received in revised form:
May 31,
2013
Received:
April 22,
2013
Footnotes
Dr. Jang has received grant support and consulting fees from the LightLab Imaging Inc., St. Jude Medical Inc . Dr. Vergallo is supported by the “Enrico ed Enrica Sovena” Foundation , Rome, Italy. Dr. Kato is supported by the Japan Heart Foundation and Bayer Yakuhin Research Grant Abroad and the Mitsukoshi Health and Welfare Foundation . Dr. Jia is supported by the National Natural Science Foundation of China (contract number: 81200076). Dr. Yu has received a grant from the National Natural Science Foundation of China (contract number: 30871064/C140401). Dr. Zhang is an employee of LightLab Imaging Inc., St. Jude Medical Inc. This study was supported by the Dr. John Nam Research Fellowship grant .
See page 1321 for disclosure information.
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© 2013 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
