Abstract 14382: Clinical Characterization of Neoatherosclerosis in vivo: Insight from Multi-Modality Optical Imaging
Re-endothelialization is delayed following drug eluting stent (DES) implantation. Neoatherosclerosis (NA), a newly described entity whereby neointima becomes lipid laden, may be more prone to develop in this setting. OCT and IVUS were used to image in-stent NA in conjunction with near infrared spectroscopy (NIRS) to detect neointimal lipid in 65 consecutive pts with in-stent restenosis (ISR). NA, defined as a signal-poor OCT region with diffuse borders, occurred in 40 ISR segments (62%) and was best predicted by a lipid core burden index (LCBI)/4mm of ≥68 (PPV 97%, P>0.001). NA was more common in DES with significantly more thin-cap NA (TCNA), higher mean total LCBI and density of LCBI (Table). Peri-procedural MI occurred only in DES (Table). Topographically NA was classified as: I (thin-cap, TCNA), II (thick-cap), III (peri-strut), and IV (outside the stent struts) (Fig, white arrow - NA, grey - stent struts, black -LCB, asterisk - TCNA). Type I was more common in DES (56% vs 14%) and Type IV in BMS (28% vs 15%; P=0.03 )(Bar Graph). No difference was found in NA between 1st (SES/PES; 53%) and 2nd generation DES (EES/ZES; 48%; P=0.35). Independent predictors of NA identified by multivariable analysis included only prior DES (OR: 7.0, 95% CI: 1.7 to 27; P=0.006).
Conclusion: In-stent NA was more common, had more TCNA and was associated with more peri-procedural MI in DES compared to BMS.
- © 2012 by American Heart Association, Inc.