Neointimal coverage of stents in human coronary arteries observed by angioscopy

Cardiovascular Division, Osaka Police Hospital, Japan.

OBJECTIVES. The aim of this study was to reveal the time course of the neointimal coverage of stents placed in the human coronary arteries. BACKGROUND. In deciding the protocol of anticoagulant and antiplatelet therapy for patients who undergo stent implantation, the condition of the neointimal coverage of stents should be taken into consideration. However, the time course of the neointimal coverage of stents has not been elucidated in human coronary arteries. METHODS. Serial angioscopic observations were performed immediately after stenting, at 8 to 45 days (short-term follow-up) and at 65 to 142 days (long-term follow-up) in patients who underwent implantation of the Wiktor coronary stent in the restenotic lesion or in the lesion of acute or threatened closure after balloon angioplasty. RESULTS. Angioscopic observations were successfully performed in 14 cases immediately after stenting, in 11 cases at short-term follow-up and in 13 cases at long-term follow-up. Immediately after stenting and even at 8 to 18 days after stenting, the stent was not covered by the neointimal layer in any case. However, at 65 to 142 days after stenting, the stent was covered by the neointimal layer in all cases. Angioscopically, three types of neointimal layer were recognized: a white layer with a cottonlike surface in three cases, a white layer with a smooth surface in eight cases and a transparent layer with a smooth surface in two cases. CONCLUSIONS. Although some experimental results in animals have shown completion of neointimal coverage of stents in a few weeks, in this serial angioscopic follow-up study, the completion of neointimal coverage of stents in human coronary arteries required approximately 3 months.

This article has been cited by other articles:

				P. O. Vandvik, A. M. Lincoff, J. M. Gore, D. D. Gutterman, F. A. Sonnenberg, P. Alonso-Coello, E. A. Akl, M. G. Lansberg, G. H. Guyatt, and F. A. Spencer Primary and Secondary Prevention of Cardiovascular Disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines Chest, February 1, 2012; 141(2_suppl): e637S - e668S. [Abstract] [Full Text] [PDF]

				M. Wada, Y. Ueda, T. Higo, K. Matsuo, M. Nishio, A. Hirata, M. Asai, T. Nemoto, T. Kashiyama, A. Murakami, et al. Chronic Kidney Disease and Coronary Artery Vulnerable Plaques Clin. J. Am. Soc. Nephrol., December 1, 2011; 6(12): 2792 - 2798. [Abstract] [Full Text] [PDF]

				T.-H. Chen and R. Matyal The Management of Antiplatelet Therapy in Patients With Coronary Stents Undergoing Noncardiac Surgery Seminars in Cardiothoracic and Vascular Anesthesia, December 1, 2010; 14(4): 256 - 273. [Abstract] [PDF]

				F. Sera, M. Awata, M. Uematsu, J.-i. Kotani, S. Nanto, and S. Nagata Optimal Stent-Sizing With Intravascular Ultrasound Contributes to Complete Neointimal Coverage After Sirolimus-Eluting Stent Implantation Assessed by Angioscopy J. Am. Coll. Cardiol. Intv., October 1, 2009; 2(10): 989 - 994. [Abstract] [Full Text] [PDF]

				T. Higo, Y. Ueda, J. Oyabu, K. Okada, M. Nishio, A. Hirata, K. Kashiwase, N. Ogasawara, S. Hirotani, and K. Kodama Atherosclerotic and thrombogenic neointima formed over sirolimus drug-eluting stent an angioscopic study. J. Am. Coll. Cardiol. Img., May 1, 2009; 2(5): 616 - 624. [Abstract] [Full Text] [PDF]

				G. Nakazawa, M. Vorpahl, A. V. Finn, J. Narula, and R. Virmani One step forward and two steps back with drug-eluting-stents from preventing restenosis to causing late thrombosis and nouveau atherosclerosis. J. Am. Coll. Cardiol. Img., May 1, 2009; 2(5): 625 - 628. [Full Text] [PDF]

				J. D. Douketis, P. B. Berger, A. S. Dunn, A. K. Jaffer, A. C. Spyropoulos, R. C. Becker, and J. Ansell The Perioperative Management of Antithrombotic Therapy: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition) Chest, June 1, 2008; 133(6_suppl): 299S - 339S. [Abstract] [Full Text] [PDF]

				P.-G. Chassot, A. Delabays, and D. R. Spahn Perioperative antiplatelet therapy: the case for continuing therapy in patients at risk of myocardial infarction Br. J. Anaesth., September 1, 2007; 99(3): 316 - 328. [Abstract] [Full Text] [PDF]

				M. Awata, J.-i. Kotani, M. Uematsu, T. Morozumi, T. Watanabe, T. Onishi, O. Iida, F. Sera, S. Nanto, M. Hori, et al. Serial Angioscopic Evidence of Incomplete Neointimal Coverage After Sirolimus-Eluting Stent Implantation: Comparison With Bare-Metal Stents Circulation, August 21, 2007; 116(8): 910 - 916. [Abstract] [Full Text] [PDF]

				D. Matsumoto, J. Shite, T. Shinke, H. Otake, Y. Tanino, D. Ogasawara, T. Sawada, O. L. Paredes, K.-i. Hirata, and M. Yokoyama Neointimal coverage of sirolimus-eluting stents at 6-month follow-up: evaluated by optical coherence tomography Eur. Heart J., April 2, 2007; 28(8): 961 - 967. [Abstract] [Full Text] [PDF]

				J.-i. Kotani, M. Awata, S. Nanto, M. Uematsu, F. Oshima, H. Minamiguchi, G. S. Mintz, and S. Nagata Incomplete Neointimal Coverage of Sirolimus-Eluting Stents: Angioscopic Findings J. Am. Coll. Cardiol., May 16, 2006; 47(10): 2108 - 2111. [Abstract] [Full Text] [PDF]

				H.-J. Priebe Perioperative myocardial infarction--aetiology and prevention Br. J. Anaesth., July 1, 2005; 95(1): 3 - 19. [Abstract] [Full Text] [PDF]

				J. S. Forrester Toward understanding the evolution of plaque rupture: Correlating vascular pathology with clinical outcomes J. Am. Coll. Cardiol., November 5, 2003; 42(9): 1566 - 1568. [Full Text] [PDF]

				S. H. Wilson, P. Fasseas, J. L. Orford, R. J. Lennon, T. Horlocker, N. E. Charnoff, S. Melby, and P. B. Berger Clinical outcome of patients undergoing non-cardiac surgery in the two months following coronary stenting J. Am. Coll. Cardiol., July 16, 2003; 42(2): 234 - 240. [Abstract] [Full Text] [PDF]

				M. Asakura, Y. Ueda, O. Yamaguchi, T. Adachi, A. Hirayama, M. Hori, and K. Kodama Extensive development of vulnerable plaques as a pan-coronary process in patients with myocardial infarction: an angioscopic study J. Am. Coll. Cardiol., April 1, 2001; 37(5): 1284 - 1288. [Abstract] [Full Text] [PDF]

				P. B. Berger, M. R. Bell, D. Hasdai, D. E. Grill, S. Melby, and D. R. Holmes Jr Safety and Efficacy of Ticlopidine for Only 2 Weeks After Successful Intracoronary Stent Placement Circulation, January 19, 1999; 99(2): 248 - 253. [Abstract] [Full Text] [PDF]

				M. Asakura, Y. Ueda, S. Nanto, A. Hirayama, T. Adachi, M. Kitakaze, M. Hori, and K. Kodama Remodeling of In-Stent Neointima, Which Became Thinner and Transparent Over 3 Years : Serial Angiographic and Angioscopic Follow-up Circulation, May 26, 1998; 97(20): 2003 - 2006. [Abstract] [Full Text] [PDF]