title: Neoatherosclerosis: Coronary stents seal atherosclerotic lesions but result in making a new problem of atherosclerosis.
abstract: Chronic inflammation of the native vessel wall with infiltration of lipid-laden foamy macrophages through impaired endothelium results in atherosclerosis. Percutaneous coronary intervention, including metallic stent implantation, is now widely utilized for the treatment of atherosclerotic lesions of the coronary artery. Bare-metal stents and the subsequently developed drug-eluting stents seal the atherosclerosis and resolve lumen stenosis or obstruction of the epicardial coronary artery and myocardial ischemia. After stent implantation, neointima proliferates within the stented segment. Chronic inflammation caused by a foreign body reaction to the implanted stent and subsequent neovascularization, which is characterized by the continuous recruitment of macrophages into the vessel, result in the transformation of the usual neointima into an atheromatous neointima. Neointima with an atherosclerotic appearance, such as that caused by thin-cap fibroatheromas, is now recognized as neoatherosclerosis, which can sometimes cause in-stent restenosis and acute thrombotic occlusion originating from the stent segment following disruption of the atheroma. Neoatherosclerosis is emerging as a new coronary stent-associated problem that has not yet been resolved. In this review article, we will discuss possible mechanisms, clinical challenges, and the future outlook of neoatherosclerosis.
authors.affiliation: Hidenori Komiyama, Masamichi Takano, Noritake Hata, Yoshihiko Seino, Cardiovascular Center, Chiba Hokusou Hospital, Nippon Medical School, Chiba 270-1613, Japan.
authors.forename: Hidenori
authors.initials: H
authors.lastname: Komiyama
authors.affiliation: Hidenori Komiyama, Masamichi Takano, Noritake Hata, Yoshihiko Seino, Cardiovascular Center, Chiba Hokusou Hospital, Nippon Medical School, Chiba 270-1613, Japan.
authors.forename: Masamichi
authors.initials: M
authors.lastname: Takano
authors.affiliation: Hidenori Komiyama, Masamichi Takano, Noritake Hata, Yoshihiko Seino, Cardiovascular Center, Chiba Hokusou Hospital, Nippon Medical School, Chiba 270-1613, Japan.
authors.forename: Noritake
authors.initials: N
authors.lastname: Hata
authors.affiliation: Hidenori Komiyama, Masamichi Takano, Noritake Hata, Yoshihiko Seino, Cardiovascular Center, Chiba Hokusou Hospital, Nippon Medical School, Chiba 270-1613, Japan.
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Seino
authors.affiliation: Hidenori Komiyama, Masamichi Takano, Noritake Hata, Yoshihiko Seino, Cardiovascular Center, Chiba Hokusou Hospital, Nippon Medical School, Chiba 270-1613, Japan.
authors.forename: Wataru
authors.initials: W
authors.lastname: Shimizu
authors.affiliation: Hidenori Komiyama, Masamichi Takano, Noritake Hata, Yoshihiko Seino, Cardiovascular Center, Chiba Hokusou Hospital, Nippon Medical School, Chiba 270-1613, Japan.
authors.forename: Kyoichi
authors.initials: K
authors.lastname: Mizuno
keywords: Atherosclerosis; Drug-eluting stent; Neoatherosclerosis; Percutaneous coronary intervention