title: In vivo virtual histology intravascular ultrasound comparison of neointimal hyperplasia within drug-eluting- versus bare metal stents.
abstract: BACKGROUND
  The process of in-stent neointimal hyperplasia (NIH) between drug-eluting stents (DES) and bare metal stents (BMS) might be different. We compared in vivo composition of in-stent NIH between DES and BMS using virtual histology-intravascular ultrasound (VH-IVUS).
  
  
  RESULTS
  Volumetric VH-IVUS was used to compare in-stent NIH between 23 DES and 15 BMS in 30 patients who underwent coronary angiography because of angina. The inner and outer VH-IVUS contours were drawn in a way to avoid the stent strut artifacts. Cross-sectional analysis was done at every VH-IVUS frame within the stent, thereby allowing volumetric measurement of stent, lumen, and NIH and its components. Baseline characteristics and IVUS measurements were similar between DES and BMS groups. The duration of follow-up was similar between DES (median 38 months [interquartile range, 7-59]) vs. BMS (median 40 months [interquartile range, 7-99]), (p=0.26). % necrotic core (NC) volume was significantly higher in DES than BMS: 19.5 [16.3, 25.6] vs. 12.1 [8.2, 18.5] (p=0.006). %NC volume significantly increased with time in BMS (p=0.007), but not in DES (p=0.24) so that at any given time point, %NC in DES was greater than in BMS. After adjustment for baseline differences, only DES (p=0.003) and stent age (p=0.043) were independent predictors of %NC volume. VH-IVUS in-stent thin-cap fibroatheromas were detected only in the DES group: 34.8% vs. 0%, p=0.013.
  
  
  CONCLUSIONS
  In vivo composition of in-stent NIH between DES and BMS was different, suggesting that the process of in-stent NIH in DES and BMS is diverse.
authors: Washington Hospital Center, Division of Cardiology, Washington, DC 20010, USA.
authors: Kohei
authors: K
authors: Wakabayashi
authors: Gary
authors: G
authors: Mintz
authors: Cedric
authors: C
authors: Delhaye
authors: Yu Jeong
authors: YJ
authors: Choi
authors: Joon Hyung
authors: JH
authors: Doh
authors: Itsik
authors: I
authors: Ben-Dor
authors: Michele
authors: M
authors: Gaglia
authors: Rajbabu
authors: R
authors: Pakala
authors: William
authors: W
authors: Suddath
authors: Lowell
authors: L
authors: Satler
authors: Kenneth
authors: K
authors: Kent
authors: Augusto
authors: A
authors: Pichard
authors: Neil
authors: N
authors: Weissman
authors: Ron
authors: R
authors: Waksman
mesh_terms: D000368:Aged; D000787:Angina Pectoris / Q000628:therapy; D015906:Angioplasty, Balloon, Coronary; D017023:Coronary Angiography; D003331:Coronary Vessels / Q000000981:diagnostic imaging* / Q000473:pathology; D054855:Drug-Eluting Stents / Q000009:adverse effects*; D005260:Female; D006801:Humans; D006965:Hyperplasia / Q000000981:diagnostic imaging / Q000473:pathology / Q000517:prevention & control; D015994:Incidence; D008297:Male; D008670:Metals / Q000009:adverse effects*; D008875:Middle Aged; D058426:Neointima / Q000000981:diagnostic imaging* / Q000473:pathology / Q000517:prevention & control; D058226:Plaque, Atherosclerotic / Q000000981:diagnostic imaging / Q000453:epidemiology; D015607:Stents / Q000009:adverse effects*; D018084:Ultrasonography, Interventional / Q000379:methods*
chemical_list: D008670:Metals