title: The role of integrated backscatter intravascular ultrasound in characterizing bare metal and drug-eluting stent restenotic neointima as compared to optical coherence tomography.
abstract: BACKGROUND
  To evaluate the role of integrated backscatter intravascular ultrasound (IB-IVUS) in assessing the morphology of neointima in bare-metal stent (BMS) and drug-eluting stent (DES) restenosis as compared to the gold-standard, optical coherence tomography (OCT).
  
  
  METHODS
  A total of 120 cross-sections were evaluated by IB-IVUS and OCT at five cross-sections from 24 patients (24 lesions): at the minimal lumen area (MLA) and at 1 and 2mm proximal and distal to the MLA site in 24 lesions (9 treated with DES and 15 treated with BMS). IB-IVUS and OCT findings were analyzed according to the time at which restenosis was identified (early <12 months and late ≥12 months) and the stent type.
  
  
  RESULTS
  IB-IVUS was found to correctly characterize the neointima of both BMS and DES in-stent restenosis (ISR) as compared to OCT. The overall agreement between the pattern of ISR neointima by IB-IVUS and that by OCT was excellent (kappa=0.85, 95% CI 0.76-0.94). Late DES ISR was characterized by more non-homogeneous, low backscatter and lipid-laden neointima, as compared to the BMS equivalent (BMS vs. DES, 45.0% vs. 80.0%, p<0.01; 51.7% vs. 85.0%, p=0.008; 33.3% vs. 65.0%, p<0.01, respectively).
  
  
  CONCLUSIONS
  IB-IVUS assessment of the ISR neointima pattern appears to provide similar information as the gold-standard OCT in patients with stable angina. Both modalities suggested that late DES restenosis is characterized by a non-homogeneous lipid-laden neointima.
authors.affiliation: Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy; Fukuyama Cardiovascular Hospital, Fukuyama, Japan. Electronic address: katsumasaz4@yahoo.co.jp.
authors.forename: Kastsumasa
authors.initials: K
authors.lastname: Sato
authors.affiliation: Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy.
authors.forename: Charis
authors.initials: C
authors.lastname: Costopoulos
authors.affiliation: Fukuyama Cardiovascular Hospital, Fukuyama, Japan.
authors.forename: Hideo
authors.initials: H
authors.lastname: Takebayashi
authors.affiliation: Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy.
authors.forename: Toru
authors.initials: T
authors.lastname: Naganuma
authors.affiliation: Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy.
authors.forename: Tadashi
authors.initials: T
authors.lastname: Miyazaki
authors.affiliation: Fukuyama Cardiovascular Hospital, Fukuyama, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Goto
authors.affiliation: Fukuyama Cardiovascular Hospital, Fukuyama, Japan.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Yamane
authors.affiliation: Fukuyama Cardiovascular Hospital, Fukuyama, Japan.
authors.forename: Arata
authors.initials: A
authors.lastname: Hagikura
authors.affiliation: Fukuyama Cardiovascular Hospital, Fukuyama, Japan.
authors.forename: Yuetsu
authors.initials: Y
authors.lastname: Kikuta
authors.affiliation: Fukuyama Cardiovascular Hospital, Fukuyama, Japan.
authors.forename: Masahito
authors.initials: M
authors.lastname: Taniguchi
authors.affiliation: Fukuyama Cardiovascular Hospital, Fukuyama, Japan.
authors.forename: Shigeki
authors.initials: S
authors.lastname: Hiramatsu
authors.affiliation: Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ito
authors.affiliation: Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Colombo
authors.affiliation: Fukuyama Cardiovascular Hospital, Fukuyama, Japan.
authors.forename: Seiichi
authors.initials: S
authors.lastname: Haruta
mesh_terms: D000368:Aged; D017023:Coronary Angiography / Q000379:methods; D023903:Coronary Restenosis / Q000000981:diagnostic imaging / Q000628:therapy*; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D008297:Male; D058426:Neointima / Q000000981:diagnostic imaging*; D011474:Prosthesis Design; D015607:Stents; D041623:Tomography, Optical Coherence; D018084:Ultrasonography, Interventional
keywords: In-stent restenosis; Integrated backscatter intravascular ultrasound; Neointima; Optical coherence tomography