Difference in neointimal appearance between early and late restenosis after sirolimus-eluting stent implantation assessed by optical coherence tomography

作者：Ino Yasushi; Kubo Takashi; Kitabata Hironori; Ishibashi Kohei; Tanimoto Takashi; Matsuo Yoshiki; Shimamura Kunihiro; Shiono Yasutsugu; Orii Makoto; Komukai Kenichi; Yamano Takashi; Yamaguchi Tomoyuki; Hirata Kumiko; Tanaka Atsushi; Mizukoshi Masato; Imanishi Toshio; Akasaka Takashi^*

来源：Coronary Artery Disease, 2013, 24(2): 95-101.

DOI：10.1097/MCA.0b013e32835c872b

• drug-eluting stent
• late restenosis
• optical coherence tomography

Objectives Late in-stent restenosis (ISR) is an important clinical issue in the drug-eluting stent era. Autopsy studies have reported different underlying mechanisms between early ISR and late ISR. The aim of the present study was to compare the neointimal tissue appearance between early ISR (< 1 year) and late ISR (> 1 year) after sirolimus-eluting stent (SES) implantation using optical coherence tomography (OCT).
Materials and methods We examined the neointimal tissue appearance in 48 ISR lesions after SES implantation [30 early ISR lesions (8 +/- 1 months after stenting) and 18 late ISR lesions (34 +/- 14 months after stenting)] by OCT. ISR was defined as percent diameter stenosis more than 50% within the stented segment in angiography. Lipid-rich neointima was characterized by signal-poor regions with diffuse borders. Thin-cap fibroatheroma (TCFA)-like neointima was defined by lipid-rich neointima with cap thickness 65 mu m or less.
Results In the OCT findings, heterogeneous neointima was more often observed in the late ISR group compared with the early ISR group (89 vs. 43%, P = 0.002). Although the frequency of intraluminal thrombus was not different between the two groups (P = 0.085), the frequency of lipid-rich neointima (83 vs. 27%, P < 0.001), TCFA-like neointima (39 vs. 10%, P = 0.028), microchannels within neointima (67 vs. 27%, P = 0.007), and neointimal disruption (33 vs. 3%, P = 0.008) was significantly higher in the late ISR group.
Conclusion In the present OCT study, it was found that atherosclerotic progression of neointima, such as lipid-rich neointima, TCFA-like neointima, microchannels, and neointimal disruption, was more often observed in late ISR lesions after SES implantation compared with early ISR ones.

• 出版日期2013-3