Abstract 12574: Difference in Optical Coherence Tomography Findings of Very Late In-Stent Restenosis Lesions Between After Bare-Metal Stent and Sirolimus-Eluting Stent Implantation
Introduction: It was reported that there are differences in tissue morphology of in-stent restenosis (ISR) lesions according to stent type and timing of restenosis. However, little is known about optical coherence tomography (OCT) findings of very late ISR lesions after bare-metal stent (BMS) and sirolimus-eluting stent (SES) implantations.
Methods: Between July 2008 and November 2013, OCT was performed in 53 ISR lesions (BMS group; 25 BMS-ISR lesions and SES group; 28 SES-ISR lesions) which had occurred beyond 5 years after stent implantation. We examined tissue structure (homogeneous, heterogeneous, or layered), incomplete stent apposition (ISA) and multiple inter-strut hollows (MIH) as indices of endothelial delayed healing, and lipid-rich intima and thin-cap fibroatheroma (TCFA) as indices of neoatherosclerosis. OCT finding of ISA was defined as separation of at least 1 stent strut from the vessel wall which is not related to a side branch, and MIH was defined as multiple hollows (the maximum depth >0.5 mm) existing between and outside the well-apposed stent struts. Lipid-rich intima was defined as a diffuse border, low signal lesion due to marked signal attenuation and lipid arc more than 90 degrees. TCFA was defined as a lipid-rich plaque with thinnest fibrous cap thickness less than 65 μm.
Results: The patients were 46 men and 7 women, and the mean age was 69.2±7.7 years. The mean time between stent implantation and OCT procedure was significantly longer in the BMS group than in the SES group (10.6±2.7 years vs. 6.1±1.0 years, p<0.001). The results are shown in the figure.
Conclusions: Although there was a difference in the stent age between the two groups, OCT findings of endothelial delayed healing were frequently observed in ISR lesions beyond 5 years after SES implantation, while those of neoatherosclerosis were frequently observed in ISR lesions beyond 5 years after BMS implantation.
Author Disclosures: T. Tada: None. K. Kadota: None. S. Habara: None. H. Tanaka: None. Y. Fuku: None. T. Goto: None. K. Mitsudo: None.
- © 2014 by American Heart Association, Inc.