title: Atherosclerotic plaque behind the stent changes after bare-metal and drug-eluting stent implantation in humans: Implications for late stent failure?
abstract: The natural history and the role of atherosclerotic plaque located behind the stent (PBS) are still poorly understood. We evaluated the serial changes in PBS following bare-metal (BMS) compared to first-generation drug-eluting stent (DES) implantation and the impact of these changes on in-stent neointimal hyperplasia (NIH).
  
  
  
  Three-dimensional coronary reconstruction by angiography and intravascular ultrasound was performed after intervention and at 6-10-month follow-up in 157 patients with 188 lesions treated with BMS (n = 89) and DES (n = 99).
  
  
  
  There was a significant decrease in PBS area (-7.2%; p < 0.001) and vessel area (-1.7%; p < 0.001) after BMS and a respective increase in both areas after DES implantation (6.1%; p < 0.001 and 4.1%; p < 0.001, respectively). The decrease in PBS area significantly predicted neointimal area at follow-up after BMS (β: 0.15; 95% confidence interval [CI]: 0.10-0.20, p < 0.001) and DES (β: 0.09; 95% CI: 0.07-0.11; p < 0.001) implantation. The decrease in PBS area was the most powerful predictor of significant NIH after BMS implantation (odds ratio: 1.13; 95% CI: 1.02-1.26; p = 0.02).
  
  
  
  The decrease in PBS area after stent implantation is significantly associated with the magnitude of NIH development at follow-up. This finding raises the possibility of a communication between the lesion within the stent and the underlying native atherosclerotic plaque, and may have important implications regarding the pathobiology of in-stent restenosis and late/very late stent thrombosis.
authors: Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA.
authors: Ioannis
authors: I
authors: Andreou
authors: Department of Cardiovascular Medicine, Shonan Kamakura General Hospital, Kanagawa, Japan.
authors: Saeko
authors: S
authors: Takahashi
authors: Department of Cardiovascular Medicine, Hokkaido University, Sapporo, Japan.
authors: Masaya
authors: M
authors: Tsuda
authors: Department of Cardiovascular Medicine, Shonan Kamakura General Hospital, Kanagawa, Japan.
authors: Koki
authors: K
authors: Shishido
authors: Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors: Antonios P
authors: AP
authors: Antoniadis
authors: Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors: Michail I
authors: MI
authors: Papafaklis
authors: Department of Cardiovascular Medicine, Shonan Kamakura General Hospital, Kanagawa, Japan.
authors: Shingo
authors: S
authors: Mizuno
authors: Mechanical and Industrial Engineering, Northeastern University, Boston, MA, USA.
authors: Ahmet U
authors: AU
authors: Coskun
authors: Department of Cardiovascular Medicine, Shonan Kamakura General Hospital, Kanagawa, Japan.
authors: Shigeru
authors: S
authors: Saito
authors: Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors: Charles L
authors: CL
authors: Feldman
authors: Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA.
authors: Elazer R
authors: ER
authors: Edelman
authors: Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: pstone@partners.org.
authors: Peter H
authors: PH
authors: Stone
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000209:etiology; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000473:pathology; D054855:Drug-Eluting Stents / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D021621:Imaging, Three-Dimensional; D007564:Japan; D008297:Male; D008670:Metals; D008875:Middle Aged; D058426:Neointima / Q000473:pathology; D058226:Plaque, Atherosclerotic / Q000188:drug therapy* / Q000503:physiopathology* / Q000601:surgery; D011446:Prospective Studies; D015607:Stents / Q000009:adverse effects*; D013927:Thrombosis / Q000209:etiology; D016896:Treatment Outcome; D014463:Ultrasonography
chemical_list: D008670:Metals
keywords: Atherosclerosis; In-stent restenosis; Neoatherosclerosis; Neointimal hyperplasia; Plaque; Stent thrombosis