title: Predominant microvessel proliferation in coronary stent restenotic tissue in patients with diabetes: insights from optical coherence tomography image analysis.
abstract: BACKGROUND
  Coronary optical coherence tomography (OCT) enables virtual depiction of histological findings of in-stent restenotic tissue. The aim of this study was to investigate the microvessel proliferation within in-stent restenotic tissue and the influence of diabetes mellitus (DM).
  
  
  METHODS
  We examined 54 in-stent restenotic coronary artery lesions (stenotic area>50%) from 50 consecutive patients including 28 with DM (56%) and 9 insulin-treated DM patients (18%); who underwent coronary time-domain OCT imaging with automatic pull back (1mm/s, 20 frames/s). Microvessels were defined as low-signal cavities with a diameter of 50-150 microns and a trajectory parallel to the lumen recognized on 3 consecutive cross-sectional OCT image frames. The microvessel index was calculated as the number of frames with microvessel/total number of frames × 100. Patients were stratified into 3 groups: 1) without microvessels, 2) with a low (< median value) microvessel index, 3) with a high microvessel index.
  
  
  RESULTS
  Microvessels were detected in 566 frames (3.1%) from 26 lesions (48%) in 24 patients (48%). A greater incidence of DM and higher serum glucose levels were observed in the high microvessel index group (DM: 42% vs 58% vs 83%, p=0.049; serum glucose level: 118.2 ± 44.6 vs 122.6 ± 31.0 vs 172.8 ± 63.1mg/dL, p=0.03 between low and high microvessel index group, p=0.005 between no microvessel and high microvessel index group).
  
  
  CONCLUSIONS
  Microvessel formation may be a unique pathophysiological factor of in-stent restenoses in patients with DM.
authors.affiliation: Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan. Electronic address: nsuzu@bronze.ocn.ne.jp.
authors.forename: Nobuaki
authors.initials: N
authors.lastname: Suzuki
authors.forename: Ken
authors.initials: K
authors.lastname: Kozuma
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kyono
authors.forename: Shuji
authors.initials: S
authors.lastname: Otsuki
authors.forename: Qiang
authors.initials: Q
authors.lastname: Fu
authors.forename: Naoyoshi
authors.initials: N
authors.lastname: Hosogoe
authors.forename: Tomohisa
authors.initials: T
authors.lastname: Saito
authors.forename: Kazuya
authors.initials: K
authors.lastname: Naito
authors.forename: Mina
authors.initials: M
authors.lastname: Ochiai
authors.forename: Shuichi
authors.initials: S
authors.lastname: Ishikawa
authors.forename: Hidenori
authors.initials: H
authors.lastname: Watanabe
authors.forename: Akiyoshi
authors.initials: A
authors.lastname: Miyazawa
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Eto
authors.forename: Takaaki
authors.initials: T
authors.lastname: Isshiki
mesh_terms: D000368:Aged; D015331:Cohort Studies; D023903:Coronary Restenosis / Q000000981:diagnostic imaging* / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000000981:diagnostic imaging* / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D055806:Microvessels / Q000000981:diagnostic imaging* / Q000502:physiology; D008875:Middle Aged; D009389:Neovascularization, Pathologic / Q000000981:diagnostic imaging*; D011859:Radiography; D012189:Retrospective Studies; D041623:Tomography, Optical Coherence / Q000379:methods*
keywords: Coronary artery; Diabetes mellitus; Stent