Abstract 18839: Difference of Optical Properties of Neointimal Tissue Between Restenosis After Drug-Eluting and Bare Metal Coronary Stent
Background: We performed morphological analysis for stent restenosis using optical coherence tomography (OCT) in patients treated with drug-eluting stent (DES) and bare metal stent (BMS).
Method: 60 Patients presenting myocardial ischemia due to angiographically documented stent restenosis more than six-month after implantation were included. OCT analysis of stented segments (%area stenosis (%AS) and OCT mean signal intensity and signal attenuation levels of neointimal tissue) were done using dedicated software. OCT structure pattern of neointimal tissue was classified into three categories; homogeneous, layered and heterogeneous followed by assessment of the response to lesion revascularization with balloon angioplasty.
Result: 24 BMS, 20 sirolimus-eluting stent (SES) and 16 paclitaxel-eluting stent (PES) were enrolled. OCT analysis showed that %AS was similar among groups (BMS: 71.0±10.2 %, SES:68.0±13.6 %, PES: 69.1±10.1%, P=NS). However, OCT mean signal intensity of neointima of the BMS (6.9±0.2 s.u.) is higher than those of SES (6.2±0.1 s.u.) and PES (6.3±0.4 s.u.) (P<0.05). OCT signal attenuation at neointima of the BMS (1.2±0.6) is lower than those of SES (1.8±1.1) and PES (1.9±0.7) (P<0.05). BMS showed dominantly homogeneous OCT pattern of neointima, while SES and PES shifted to layered or heterogeneous pattern (BMS: 83%, 17% and 0%; SES: 25%, 60% and 15%; PES: 31%, 38% and 31% for homogeneous, layered and heterogeneous). Reduction of neointimal tissue area after balloon angioplasty is higher in layered lesion than homogeneous lesion (%reduction; Homogeneous: 21±12%, Layered: 60±13%, heterogeneous: 46±6%).
Conclusion: OCT derived morphology of neointimal tissue at stent restenosis after PES and SES demonstrated different from that of BMS, which were possibly originated from thrombotic and /or hypo-cellular neointimal tissue formation. OCT assessment of neointimal tissue pattern may help to predict acute response to balloon angioplasty for the treatment of stent restenosis.
- © 2010 by American Heart Association, Inc.