We found a match
Your institution may have rights to this item. Sign in to continue.
- Title
In-stent restenosis assessed with frequency domain optical coherence tomography shows smooth coronary arterial healing process in second-generation drug-eluting stents.
- Authors
Takashi Kajiya; Hiroshi Yamaguchi; Junichiro Takaoka; Kengo Fukunaga; Ryoichi Arima; Akihiro Miyamura; Toshiko Ninomiya; Nobuhiko Atsuchi; Yoshihiko Atsuchi; Mitsuyasu Terashima; Hideaki Kaneda; Mitsuru Ohishi; Kajiya, Takashi; Yamaguchi, Hiroshi; Takaoka, Junichiro; Fukunaga, Kengo; Arima, Ryoichi; Miyamura, Akihiro; Ninomiya, Toshiko; Atsuchi, Nobuhiko
- Abstract
<bold>Introduction: </bold>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).<bold>Methods: </bold>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.<bold>Results: </bold>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).<bold>Conclusion: </bold>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.
- Subjects
OPTICAL coherence tomography; CORONARY angiography; MORPHOLOGY; PATHOLOGICAL physiology
- Publication
Singapore Medical Journal, 2019, Vol 60, Issue 1, p48
- ISSN
0037-5675
- Publication type
journal article
- DOI
10.11622/smedj.2018038