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Neoatherosclerosis may cause late failure in DES
Thin-cap neoatheroma and in-stent restenosis occur more frequently in drug-eluting stents compared with bare-metal stents, according to findings published in Circulation: Cardiovascular Interventions.
The researchers found that neointima can become more lipid-laden and lead to neoatherosclerosis or increased plaque vulnerability in the setting of re-endothelialization after DES implantation.
Clinicians used optical coherence tomography and near-infrared spectroscopy with IVUS to characterize neoatherosclerosis in a cohort of patients with in-stent restenosis.
The analysis included 51 patients treated with DES and 14 treated with BMS who were evaluated a median of 33 months after stent implantation.
The ratio of in-stent restenosis was 62% overall, according to OCT-verified neoatherosclerosis. The rate was 68% in DES compared with 36% in BMS (P=.02). Thin-cap neoatheroma was 47% for DES and 7% in BMS (P=.01).
The total lipid core burden index was 34 (interquartile range [IQR], 12-92) for DES and 9 (IQR, 0-32) for BMS, according to near-infrared spectroscopy assessment, which also demonstrated that the density of lipid core burden index/4 mm was 144 (IQR, 60-285) in DES and 26 (IQR, 0-86; P<.001) in BMS.
The researchers classified thin-cap neoatherosclerosis as type I, thick-cap neoatherosclerosis as type II and peri-strut neoatherosclerosis as type III.
Type I thin-cap neoatheroma was 20% in the DES group vs. 3% in the BMS group (P=.01). In areas of the stented segment without significant in-stent restenosis, thin-cap restenosis was 71%.
Only patients in the DES arm experienced periprocedural MI (11 vs. 0; P=.05). Fifty-five percent of these events occurred in segments with >70% in-stent restenosis.
Logistic analysis results indicated that DES was the only variable that independently predicted neoatherosclerosis (OR=7.0; 95% CI, 1.7-27) and periprocedural MI (OR=1.8; 95% CI, 1.1-2.4).
“In-stent thin-cap neoatheroma is more prevalent, is distributed more diffusely across the stented segment, and is associated with increased periprocedural myocardial infarction in DES compared with bare-metal stents,” the researchers concluded, adding that the findings indicate that neoatherosclerosis may be a mechanism for late failure of DES.
Disclosure: The study was partially funded by the Color Registry (Infraredx). Two researchers report receiving financial support from the NIH, and one reported being a founder/minor stockholder of Infraredx.