In-stent restenosis assessed with frequency domain optical coherence tomography shows smooth coronary arterial healing process in second-generation drug-eluting stents.

Takashi Kajiya; Hiroshi Yamaguchi; Junichiro Takaoka; Kengo Fukunaga; Ryoichi Arima; Akihiro Miyamura; Toshiko Ninomiya; Nobuhiko Atsuchi; Yoshihiko Atsuchi; Mitsuyasu Terashima; Hideaki Kaneda; Mitsuru Ohishi

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In-stent restenosis assessed with frequency domain optical coherence tomography shows smooth coronary arterial healing process in second-generation drug-eluting stents.

Author: Takashi KAJIYA ¹ ; Hiroshi YAMAGUCHI ² ; Junichiro TAKAOKA ¹ ; Kengo FUKUNAGA ¹ ; Ryoichi ARIMA ¹ ; Akihiro MIYAMURA ¹ ; Toshiko NINOMIYA ¹ ; Nobuhiko ATSUCHI ¹ ; Yoshihiko ATSUCHI ¹ ; Mitsuyasu TERASHIMA ³ ; Hideaki KANEDA ⁴ ; Mitsuru OHISHI ⁵
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1. Department of Cardiology, Tenyoukai Central Hospital, Kagoshima, Japan.
2. Yamaguchi Hiroshi Clinic, Kagoshima, Japan.
3. Toyohashi Heart Center, Toyohashi, Japan.
4. Okinaka Memorial Institute for Medical Research, Tokyo, Japan.
5. Department of Cardiovascular Medicine and Hypertension, Kagoshima University, Kagoshima, Japan.
Publication Type:Journal Article
Keywords: DES; drug-eluting stent; optical coherence tomography
MeSH: Aged; Constriction, Pathologic; pathology; Coronary Angiography; Coronary Restenosis; diagnostic imaging; pathology; Coronary Vessels; diagnostic imaging; pathology; surgery; Drug-Eluting Stents; adverse effects; Female; Humans; Incidence; Male; Metals; Middle Aged; Neointima; Retrospective Studies; Tomography, Optical Coherence
From:Singapore medical journal 2019;60(1):48-51
CountrySingapore
Language:English
Abstract: INTRODUCTION:The pathophysiology and mechanism of in-stent restenosis (ISR) after implantation of second-generation drug-eluting stents (DESs) are not fully clear. We compared the morphological characteristics of ISR between first- and second-generation DESs using frequency domain optical coherence tomography (OCT).
METHODS:Patients who underwent follow-up coronary angiography (CAG) after first-generation (CYPHER™ and TAXUS™) and second-generation (Nobori®, PROMUS Element™, Resolute Integrity and XIENCE) DES implantations were examined. ISR was defined as lesions of over 50% diameter stenosis at follow-up CAG. Frequency domain OCT was performed at the time of revascularisation of ISR. Tissue morphology was assessed at minimum lumen area. OCT images of DESs at both early (≤ 1 year) and late (> 1 year) phase follow-up were compared.
RESULTS:On qualitative OCT assessment, the ratios of homogeneous, layered, heterogeneous without-attenuation and heterogeneous with-attenuation morphologies were 57.1%, 17.1%, 20.0% and 5.7%, respectively, for second-generation DES ISR (n = 35), and 16.7%, 25.0%, 25.0% and 33.3%, respectively, for first-generation DES ISR (n = 36). At late phase follow-up, homogeneous morphology was significantly more common for second-generation DES ISR compared to first-generation DES ISR (first-generation: 8.0% vs. second-generation: 50.0%; p < 0.01) while heterogeneous with-attenuation morphology was significantly more common for first-generation DES ISR (first-generation: 44.0% vs. second-generation: 5.6%; p < 0.01).
CONCLUSION:Homogeneous tissue morphology was more frequently found for second-generation than first-generation DES ISR, especially in the late phase. This suggested that neointimal hyperplasia was the main mechanism in second-generation DES ISR, and that the neointima was stabilised, much like in bare metal stent implantation.