Abstract 17117: Progression of Vessel Healing and Neoatherosclerosis After Sirolimus-Eluting Stent Implantation: Comparisons of Serial Optical Coherence Tomography Findings Between Mid-and Late-Phase Follow-Up
Background; A recent report has demonstrated a possible link between neointimal atherosclerotic change and late in-stent restenosis after sirolimus-eluting stent (SES) implantation. This study is to clarify the natural history of neoatherosclerosis after SES implantation by serial optical coherence tomography (OCT) evaluation.
Methods; Sixty-four SES from 47 event-free patients were evaluated by OCT 6 months (mid-phase) and 5 years (late-phase) after implantation. In addition to standard OCT variables, the frequency of atherogenic neointima (AN) was evaluated. Atherogenic neointima was defined as neointima containing a diffuse border and a signal-poor region with invisible struts underneath due to marked signal attenuation.
Results; The percentage of uncovered and malapposed struts significantly decreased from the mid- to the late-phase follow-up (5.0% to 0.7%, p<0.0001; and 1.5% to 0.2%, p<0.0001, respectively). In contrast, stents with AN increased from the mid- to late-phase follow-up (from 3.1% to 23.4%, p=0.001). Multivariate analysis revealed that fasting serum triglyceride level at the late-phase follow-up was the only factor independently associated with the presence of AN (OR: 1.022; 95% CI: 1.002 to 1.043; p=0.03).
Conclusion; Improved neointimal coverage without excess neointimal proliferation was observed by serial OCT analysis after SES implantation. The frequencies of uncovered and malapposed struts decreased over time, suggesting that continuous vessel healing occurred in the majority of SES 5 years after stenting. Atherogenic neointima was observed mostly at the late-phase follow-up, suggesting that neoatherosclerosis, which is associated with high serum triglyceride levels, progressed over time.
- © 2012 by American Heart Association, Inc.