title: Neoatherosclerosis and mural thrombus detection after sirolimus-eluting stent implantation.
abstract: BACKGROUND
  Although both optical coherence tomography (OCT) and angioscopy are robust tools for detecting intrastent thrombi and neoatherosclerosis in vivo, whether OCT findings are comparable with angioscopy findings remains unclear.
  
  
  RESULTS
  22 patients presenting with de novo lesions underwent 26 sirolimus-eluting stent (SES) implantations, with follow-up OCT and angioscopy at 10 months post-implantation for segmental assessment of the proximal, mid-, and distal SES segments (66 segments). The mean signal intensity index (signal intensity of the neointima/signal intensity of fibrous intimal hyperplasia) was quantified for angioscopically detected in-stent yellow and white segments. The detection rate for red thrombi was numerically higher with angioscopy than with OCT (17% vs. 9%; P=0.053). Angioscopically detected in-stent yellow segments were categorized into 3 OCT patterns: "high-attenuation tissue covering struts" (OCT-defined neoatherosclerosis), "high-attenuation tissue underneath struts," and "low-attenuation and low-intensity tissue covering struts"; further, macrophage-like appearance was most frequently observed with OCT-defined neoatherosclerosis (56%, 6.3%, and 0%, respectively, P<0.001). The mean signal intensity index of neoatherosclerosis was significantly lower than that of angioscopically detected in-stent white segments (0.929 vs. 0.997, P=0.004).
  
  
  CONCLUSIONS
  Current OCT-based definitions for thrombus detection may underestimate the presence of subclinical red thrombi. Qualitative and quantitative OCT assessments of the neointima may enhance the detection of neoatherosclerosis over SES in vivo.
authors.affiliation: Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine.
authors.forename: Takumi
authors.initials: T
authors.lastname: Inoue
authors.forename: Toshiro
authors.initials: T
authors.lastname: Shinke
authors.forename: Hiromasa
authors.initials: H
authors.lastname: Otake
authors.forename: Masayuki
authors.initials: M
authors.lastname: Nakagawa
authors.forename: Hirotoshi
authors.initials: H
authors.lastname: Hariki
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Osue
authors.forename: Masamichi
authors.initials: M
authors.lastname: Iwasaki
authors.forename: Yu
authors.initials: Y
authors.lastname: Taniguchi
authors.forename: Ryo
authors.initials: R
authors.lastname: Nishio
authors.forename: Noritoshi
authors.initials: N
authors.lastname: Hiranuma
authors.forename: Akihide
authors.initials: A
authors.lastname: Konishi
authors.forename: Hiroto
authors.initials: H
authors.lastname: Kinutani
authors.forename: Junya
authors.initials: J
authors.lastname: Shite
authors.forename: Ken-Ichi
authors.initials: K
authors.lastname: Hirata
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D050197:Atherosclerosis / Q000209:etiology / Q000473:pathology*; D017023:Coronary Angiography; D054855:Drug-Eluting Stents; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013927:Thrombosis / Q000209:etiology / Q000473:pathology*; D041623:Tomography, Optical Coherence