title: Incidence and classification of neointimal proliferation and in-stent restenosis in post-stenting patients at 1-year interval: findings from non-invasive coronary computed tomography angiography.
abstract: OBJECTIVE
  To evaluate the incidence of coronary in-stent restenosis (ISR) and neointimal proliferation by coronary CT angiography (CCTA) at 1-year follow-up in asymptomatic patients.
  
  
  METHODS
  234 patients (mean age: 67 ± 10.2 years, range 39-88 years, 180 males and 54 females) with 379 stents were prospectively enrolled in this study. Binary ISR was classified by CCTA into 4 types using Mehran classification. Neointimal proliferation was similarly classified into focal and diffuse types. All patients with CCTA-revealed ISR or neointimal proliferation underwent further invasive coronary angiography (ICA) for validation. Fisher's exact test was used for comparison.
  
  
  RESULTS
  ICA revealed patent stents with neointimal proliferation in 39 patients (16.7%, 39/234) and binary ISR in 23 patients (9.8%, 23/234). Lesion-based analysis showed 12 type I ISR lesions, 4 type II ISR lesions, 1 type III ISR lesion and 7 type IV ISR lesions. Among cases with neointimal proliferation, 27 lesions were classified as focal type whereas 13 lesions were classified as diffuse type. Patients with diabetes mellitus were associated with higher incidence of CCTA-revealed neointimal proliferation (21/77 vs. 18/157, p=0.002) as well as ISR (12/77 vs. 11/157, p=0.038), compared to patients without diabetes. CCTA was found to have good diagnostic performance for neointimal proliferation and ISR detection as well as classification, with an overall accuracy of 84.4% (54/64).
  
  
  CONCLUSIONS
  Silent ISR as well as neointimal proliferation is not uncommon findings in asymptomatic post-stenting patients at 1-year interval, as revealed by CCTA. Patients with diabetes are prone to have higher incidence of neointimal proliferation.
authors.affiliation: Department of Radiology, East Hospital, Tongji University School of Medicine, No. 150, Jimo Road, Shanghai 200120, China. Electronic address: southmuch@hotmail.com.
authors.forename: Nan
authors.initials: N
authors.lastname: Xu
authors.affiliation: Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600, Yishan Road, Shanghai 200233, China. Electronic address: andrewssmu@msn.com.
authors.forename: Jiayin
authors.initials: J
authors.lastname: Zhang
authors.affiliation: Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600, Yishan Road, Shanghai 200233, China. Electronic address: drliminghua@gmail.com.
authors.forename: Minghua
authors.initials: M
authors.lastname: Li
authors.affiliation: Department of Cardiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600, Yishan Road, Shanghai 200233, China. Electronic address: drpanjingwei@gmail.com.
authors.forename: Jingwei
authors.initials: J
authors.lastname: Pan
authors.affiliation: Department of Cardiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600, Yishan Road, Shanghai 200233, China. Electronic address: drluzhigang@gmail.com.
authors.forename: Zhigang
authors.initials: Z
authors.lastname: Lu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D055424:Cardiac-Gated Imaging Techniques; D003287:Contrast Media; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000145:classification* / Q000000981:diagnostic imaging*; D003920:Diabetes Mellitus / Q000473:pathology; D005260:Female; D006801:Humans; D015994:Incidence; D007479:Iopamidol; D008875:Middle Aged; D058426:Neointima / Q000473:pathology*; D011446:Prospective Studies; D012307:Risk Factors; D015607:Stents; D014057:Tomography, X-Ray Computed
chemical_list: D003287:Contrast Media; D007479:Iopamidol
keywords: Computed tomography; Coronary artery disease; In-stent restenosis; Neointimal proliferation