title: Renal dysfunction and atherosclerosis of the neointima following bare metal stent implantation.
abstract: BACKGROUND
  Recently, neoatherosclerosis within the neointima after bare metal stent (BMS) implantation, which could cause late restenosis and very late stent thrombosis, has been a cause of concern. Renal dysfunction has been related to late cardiovascular events after coronary intervention. The present study was conducted focusing on the relationship between renal dysfunction and neointimal tissue characteristics with BMS restenosis using integrated backscatter intravascular ultrasound (IB-IVUS).
  
  
  METHODS
  We prospectively performed IB-IVUS in 80 consecutive patients requiring target lesion revascularization after BMS implantation; the patients were divided into two groups according to the estimated glomerular filtration [eGFR: ≥60 (n = 49) and <60 ml/min/1.73 m(2) (n = 31)].
  
  
  RESULTS
  Patients with eGFR <60 ml/min/1.73 m(2) had a significantly higher percentage of lipid tissue volume within the neointima and a lower percentage of fibrous tissue volume than those with eGFR ≥60 ml/min/1.73 m(2) (23.2 ± 9.4 vs. 18.0 ± 7.0%, p = 0.005, and 75.3 ± 9.3 vs. 80.4 ± 7.0%, p = 0.007, respectively). Using logistic regression analysis, eGFR <60 ml/min/1.73 m(2) and duration from stent implantation ≥48 months were independent predictors of increased lipid tissue volume within the neointima (odds ratio, 3.93; 95% confidence interval, 1.15-13.46, p = 0.03, and odds ratio, 7.56; 95% confidence interval, 2.02-28.30, p = 0.003, respectively).
  
  
  CONCLUSIONS
  Lower eGFR levels were associated with greater lipid tissue volume within the neointima after BMS deployment, suggesting the development of atherosclerosis. Renal dysfunction may affect neointimal tissue characteristics and thus leading to an increased risk of late stent failure.
authors.affiliation: Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan. s.hayano@med.nagoya-u.ac.jp
authors.forename: Shinji
authors.initials: S
authors.lastname: Hayano
authors.forename: Hideki
authors.initials: H
authors.lastname: Ishii
authors.forename: Satoshi
authors.initials: S
authors.lastname: Ichimiya
authors.forename: Masaaki
authors.initials: M
authors.lastname: Kanashiro
authors.forename: Junji
authors.initials: J
authors.lastname: Watanabe
authors.forename: Susumu
authors.initials: S
authors.lastname: Suzuki
authors.forename: Daiji
authors.initials: D
authors.lastname: Yoshikawa
authors.forename: Kengo
authors.initials: K
authors.lastname: Maeda
authors.forename: Tatsuaki
authors.initials: T
authors.lastname: Matsubara
authors.forename: Toyoaki
authors.initials: T
authors.lastname: Murohara
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging*; D023903:Coronary Restenosis / Q000150:complications / Q000000981:diagnostic imaging*; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D058426:Neointima / Q000000981:diagnostic imaging*; D062645:Percutaneous Coronary Intervention; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000150:complications*; D015607:Stents; D018084:Ultrasonography, Interventional