This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Takano, M. Articles by Mizuno, K. Search for Related Content PubMed Articles by Takano, M. Articles by Mizuno, K. Related Collections Related Articles

CLINICAL RESEARCH: INTERVENTIONAL CARDIOLOGY

Appearance of Lipid-Laden Intima and Neovascularization After Implantation of Bare-Metal Stents

Extended Late-Phase Observation by Intracoronary Optical Coherence Tomography

Masamichi Takano, MD^_*,_*, Masanori Yamamoto, MD, Shigenobu Inami, MD^_*, Daisuke Murakami, MD, Takayoshi Ohba, MD, Yoshihiko Seino, MD and Kyoichi Mizuno, MD^_*

^_* Division of Cardiology, Nippon Medical School, Tokyo, Japan
Cardiovascular Center, Chiba-Hokusoh Hospital, Nippon Medical School, Chiba, Japan

Manuscript received May 27, 2009; revised manuscript received August 28, 2009, accepted August 31, 2009.

^_* Reprint requests and correspondence: Dr. Masamichi Takano, Division of Cardiology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8602, Japan (Email: takanom{at}nms.ac.jp).

Objectives: We examined the neointimal characteristics of bare-metal stents (BMS) in extended late phase by the use of optical coherence tomography (OCT).

Background: The long-term neointimal features after BMS implantation have not yet been fully characterized.

Methods: Intracoronary OCT observation of BMS segments was performed during the early phase (<6 months, n = 20) and late phase (5 years, n = 21) after implantation. Internal tissue of the BMS was categorized into normal neointima, characterized by a signal-rich band without signal attenuation, or lipid-leaden intima, with marked signal attenuation and a diffuse border. In addition, the presence of disrupted intima and thrombus was evaluated. Neovascularization was defined as small vesicular or tubular structures, and the location of the microvessels was classified into peristent or intraintima.

Results: Normal neointima proliferated homogeneously, and lipid-laden intima was not observed in the early phase. In the late phase, lipid-laden intima, intimal disruption, and thrombus frequently were found in comparison with the early phase (67% vs. 0%, 38% vs. 0%, and 52% vs. 5%, respectively; p < 0.05). Peristent neovascularization demonstrated a similar incidence between the 2 phases. The appearance of intraintima neovascularization was more prevalent in the late phase than the early phase (62% vs. 0%, respectively; p < 0.01) and in segments with lipid-laden intima than in nonlipidic segments (79% vs. 29%, respectively; p = 0.026).

Conclusions: This OCT study suggests that neointima within the BMS often transforms into lipid-laden tissue during an extended period of time and that expansion of neovascularization from peristent to intraintima contributes to atherosclerotic progression of neointima.

Key Words: neointima • stents • thrombus

Abbreviations and Acronyms   ACS = acute coronary syndrome   BMS = bare-metal stent(s)   DS = diameter stenosis   ISR = in-stent restenosis   OCT = optical coherence tomography   TCFA = thin-cap fibroatheroma   TLR = target lesion revascularization

Related Articles

Late Vascular Healing Response to Stents: New Insights From Optical Coherence Tomography

Brigitta C. Brott
J. Am. Coll. Cardiol. 2010 55: 33-34. [Full Text] [PDF]

This article has been cited by other articles:

				H. C. Lowe, J. Narula, J. G. Fujimoto, and I.-K. Jang Intracoronary Optical Diagnostics: Current Status, Limitations, and Potential J. Am. Coll. Cardiol. Intv., December 1, 2011; 4(12): 1257 - 1270. [Abstract] [Full Text] [PDF]

				A. N. DeMaria, J. J. Bax, O. Ben-Yehuda, G. K. Feld, B. H. Greenberg, J. Hall, M. Hlatky, W. Y. W. Lew, J. A. C. Lima, A. S. Maisel, et al. Highlights of the Year in JACC 2010 J. Am. Coll. Cardiol., January 25, 2011; 57(4): 480 - 514. [Full Text] [PDF]

				D. R. Holmes Jr, D. J. Kereiakes, S. Garg, P. W. Serruys, G. J. Dehmer, S. G. Ellis, D. O. Williams, T. Kimura, and D. J. Moliterno Stent Thrombosis J. Am. Coll. Cardiol., October 19, 2010; 56(17): 1357 - 1365. [Abstract] [Full Text] [PDF]

				M. Takano, M. Yamamoto, M. Mizuno, D. Murakami, T. Inami, N. Kimata, K. Murai, N. Kobayashi, K. Okamatsu, T. Ohba, et al. Late Vascular Responses From 2 to 4 Years After Implantation of Sirolimus-Eluting Stents: Serial Observations by Intracoronary Optical Coherence Tomography Circ Cardiovasc Interv, October 1, 2010; 3(5): 476 - 483. [Abstract] [Full Text] [PDF]

				K. Yamaji, T. Kimura, T. Morimoto, Y. Nakagawa, K. Inoue, Y. Soga, T. Arita, S. Shirai, K. Ando, K. Kondo, et al. Very Long-Term (15 to 20 Years) Clinical and Angiographic Outcome After Coronary Bare Metal Stent Implantation Circ Cardiovasc Interv, October 1, 2010; 3(5): 468 - 475. [Abstract] [Full Text] [PDF]

				J. Hou, H. Qi, M. Zhang, L. Ma, H. Liu, Z. Han, L. Meng, S. Yang, S. Zhang, B. Yu, et al. Development of lipid-rich plaque inside bare metal stent: possible mechanism of late stent thrombosis? An optical coherence tomography study Heart, August 1, 2010; 96(15): 1187 - 1190. [Abstract] [Full Text] [PDF]

				B. C. Brott Late Vascular Healing Response to Stents: New Insights From Optical Coherence Tomography J. Am. Coll. Cardiol., January 5, 2010; 55(1): 33 - 34. [Full Text] [PDF]