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01-09-2019 | Original Paper

Qualitative and quantitative neointimal characterization by optical coherence tomography in patients presenting with in-stent restenosis

Authors: Erion Xhepa, Robert A. Byrne, Fernando Rivero, Andi Rroku, Javier Cuesta, Gjin Ndrepepa, Sebastian Kufner, Teresa Bastante Valiente, Salvatore Cassese, Marcos Garcia-Guimaraes, Anna Lena Lahmann, Himanshu Rai, Heribert Schunkert, Michael Joner, María José Pérez-Vizcayno, Nieves Gonzalo, Fernando Alfonso, Adnan Kastrati

Published in: Clinical Research in Cardiology | Issue 9/2019

Abstract

Aims

To describe optical coherence tomography (OCT) findings in patients with in-stent restenosis (ISR) and determine predictors of neointimal patterns and neoatherosclerosis.

Methods and results

Patients undergoing OCT prior to PCI for ISR in three European centres were included. Analyses were performed in a core laboratory. Qualitative and quantitative [gray-scale signal intensity (GSI)] neointima analyses were performed on a per quadrant basis. A total of 107 patients were included. Predominantly homogeneous lesions included 4.5% (0.0–14.3) non-homogeneous quadrants, while predominantly non-homogeneous ones included 28.1% (20.3–37.5) homogeneous quadrants. Mean GSI values differed significantly between homogeneous [108.4 (92.5–123.6)], non-homogeneous [79.9 (61.2–95.9)], and neoatherosclerosis [88.3 (72.8–104.9)] quadrants (p < 0.001 for all comparisons). Stent underexpansion was observed in 48.5% and 61.1% of lesions, respectively (p = 0.225). Female sex and maximal neointimal thickness independently correlate with a non-homogeneous pattern, while angiographic pattern and diabetes mellitus inversely correlate with such pattern. Time from index stenting procedure was the only independent predictor of neoatherosclerosis.

Conclusions

Different neointimal patterns coexist in a significant proportion of ISR lesions. GSI values differ significantly between neointimal categories. Neoatherosclerosis is a time-dependent phenomenon, displaying different time courses in DES compared to BMS, with earlier appearance in the former group. Stent underexpansion is a frequent finding in patients with ISR.

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Title: Qualitative and quantitative neointimal characterization by optical coherence tomography in patients presenting with in-stent restenosis
Authors: Erion Xhepa
Robert A. Byrne
Fernando Rivero
Andi Rroku
Javier Cuesta
Gjin Ndrepepa
Sebastian Kufner
Teresa Bastante Valiente
Salvatore Cassese
Marcos Garcia-Guimaraes
Anna Lena Lahmann
Himanshu Rai
Heribert Schunkert
Michael Joner
María José Pérez-Vizcayno
Nieves Gonzalo
Fernando Alfonso
Adnan Kastrati
Publication date: 01-09-2019
Publisher: Springer Berlin Heidelberg
Published in: Clinical Research in Cardiology / Issue 9/2019
Print ISSN: 1861-0684
Electronic ISSN: 1861-0692
DOI: https://doi.org/10.1007/s00392-019-01439-5

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Qualitative and quantitative neointimal characterization by optical coherence tomography in patients presenting with in-stent restenosis

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Methods and results

Conclusions

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