title: Optical coherence tomography-based evaluation of in-stent neoatherosclerosis in lesions with more than 50% neointimal cross-sectional area stenosis.
abstract: OBJECTIVE
  To use optical coherence tomography (OCT) to evaluate the time course, risk factors, and clinical implication of in-stent neoatherosclerosis.
  
  
  RESULTS
  The neointimal characteristics of 152 lesions, 128 drug-eluting stents (DESs) and 24 bare metal stents (BMSs), with >50% percent cross-sectional area (CSA) neointimal stenosis were evaluated. Neoatherosclerosis was defined as neointima with presence of lipid or calcification. Neoatherosclerosis was observed in 54 lesions (35.5%, 35 DESs and 19 BMSs). Median time to follow-up was 70.7 months in lesions with neoatherosclerosis (longer than lesions without neoatherosclerosis [13.4 months, p<0.001]): 58.7 months in DES-treated lesions and 129.5 months in BMS-treated lesions (p<0.001). The optimal cut-off time to predict neoatherosclerosis in DES-treated lesions was 30 months with a sensitivity of 91.4% and a specificity of 72.0% (area under curve: 0.839, 95% confidence interval: 0.764-0.898, p<0.001). Independent risk factors for neoatherosclerosis were stent age, use of first-generation DES and hypertension. Patients with neoatherosclerosis (versus without neoatherosclerosis) had a higher rate of target lesion revascularisation (92.6% vs. 77.6%, respectively, p=0.018) and stent thrombosis (14.8% vs. 0%, respectively, p<0.001).
  
  
  CONCLUSIONS
  Neoatherosclerosis occurred in one-third of stented lesions with >50% percent CSA stenosis of neointima. Late-phase development of neoatherosclerosis might be associated with clinical deterioration of stented lesions.
authors.affiliation: Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Seung-Yul
authors.initials: SY
authors.lastname: Lee
authors.forename: Dong-Ho
authors.initials: DH
authors.lastname: Shin
authors.forename: Gary S
authors.initials: GS
authors.lastname: Mintz
authors.forename: Jung-Sun
authors.initials: JS
authors.lastname: Kim
authors.forename: Byeong-Keuk
authors.initials: BK
authors.lastname: Kim
authors.forename: Young-Guk
authors.initials: YG
authors.lastname: Ko
authors.forename: Donghoon
authors.initials: D
authors.lastname: Choi
authors.forename: Yangsoo
authors.initials: Y
authors.lastname: Jang
authors.forename: Myeong-Ki
authors.initials: MK
authors.lastname: Hong
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D050197:Atherosclerosis / Q000473:pathology; D003251:Constriction, Pathologic / Q000473:pathology; D023921:Coronary Stenosis / Q000473:pathology*; D003331:Coronary Vessels / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D058426:Neointima / Q000175:diagnosis / Q000453:epidemiology* / Q000473:pathology; D015607:Stents / Q000009:adverse effects*; D013997:Time Factors; D041623:Tomography, Optical Coherence / Q000379:methods