Abstract 2468: Determinants of Incomplete Neointimal Coverage Following Stent Implantation: an Angioscopic Study
Background: Optimal healing, that is, functioning re-endothelialization without surplus smooth muscle cell proliferation, is required to avoid poor outcomes following stent implantation. Drug-eluting stents (DES) and radiation therapy reduce neointimal proliferation; however, the neointimal formation in these patients is poorly understood. Angioscopy is a suitable tool for assessing the thin neointima over the stent. The aim of this study was to elucidate the determinants of the incomplete neointimal coverage using angioscopy.
Methods: We evaluated the neointimal coverage grades in 161 stented segments from 95 consecutive patients who did not receive repeat angioplasty at follow-up (230±105 days). The neointimal coverage was classified into two groups: when stent struts bulged into the lumen, incomplete coverage; when struts were completely embedded by the neointima, complete coverage. Fourteen post-radiation and 61 DES were included in this study.
Results: Of the stented segments 34.8% showed incomplete coverage, and 96.4% of them had received either radiation or DES implantation. The parameters associated with incomplete coverage (P<0.05) are listed in the table⇓. Patient and lesion background was similar between incomplete and complete coverage, except for the history of diabetes and previous myocardial infarction (MI). Total cholesterol was also similar between incomplete and complete coverage (189±40 versus 190±34 mg/dl, P=0.9). Multivariate analysis showed that the determinants of the incomplete neointimal coverage following stent implantation were absence of previous MI (r=−0.3), less statin intake (r=−0.5), and use of DES (r=0.8, P<0.0001 for each).
Conclusions: Determinants of neointimal proliferation following stent implantation were multifactorial. Stent selection and the pleiotropic effects of statins may contribute to the optimal healing.