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Int J Cardiovasc Imaging (2014) 30:10031011 DOI 10.1007/s10554-014-0437-5
ORIGINAL PAPER
Temporal course of neointimal hyperplasia following drug-eluting stent implantation: a serial follow-up optical coherence tomography analysis
Seung-Yul Lee Myeong-Ki Hong Gary S. Mintz Dong-Ho Shin
Jung-Sun Kim Byeong-Keuk Kim Young-Guk Ko Donghoon Choi
Yangsoo Jang
Received: 30 December 2013 / Accepted: 28 April 2014 / Published online: 8 May 2014 Springer Science+Business Media Dordrecht 2014
Abstracts We sought to evaluate the temporal course of neointimal hyperplasia (NIH) after drug-eluting stent (DES) implantation, using serial optical coherence tomography (OCT). We identied 89 DES (82 patients) that had at least three consecutive cross-sections with a mean NIH thickness [100 lm on rst follow-up OCT.
Qualitative and quantitative changes in NIH were then assessed at a second follow-up OCT. NIH regression and progression were dened as a decrease or increase in mean NIH cross-sectional area [0.2 mm2, respectively, between the two studies. Between the rst and second OCT there was a decrease in NIH in 29 lesions (32.6 %), and an increase in NIH in 37 lesions (41.6 %). Compared to patients with neointimal progression, those with regression showed lower levels of high sensitivity C-reactive protein (hsCRP) (p = 0.036) and higher levels of high-density lipoprotein (p = 0.012). Between the rst and the second OCT, there were no signicant changes in NIH morphologic patterns in 67 (75.3 %) of 89 DES. In lesions with NIH regression, the evolution of heterogeneous to homogeneous neointima was observed, while the evolution of
heterogeneous or homogeneous to layered neointima or the evolution of heterogeneous, homogeneous, or layered neointima to neoatherosclerosis was detected in lesions with NIH progression (p \ 0.001). The hsCRP level at index procedure was signicantly associated with neointimal regression in multivariate model (odds ratio 0.891, 95 % condence interval 0.7960.999, p = 0.048). During late follow-up, OCT shows both NIH progression and regression that are paralleled by qualitative changes indicating increasing stability (in regression) and increasing instability (in progression).
Keywords Optical coherence tomography Stent
Coronary artery disease
Introduction
Serial changes of neointimal hyperplasia (NIH) following bare-metal stent implantation show a biphasic pattern in which NIH increases within 6 months and then decreases between 6 months and 3 years after stent implantation [1, 2] Conversely, angiographic and intravascular ultrasound...