Utility of near-infrared spectroscopy for detection of thin-cap neoatherosclerosis.
OBJECTIVE
Near-infrared spectroscopy (NIRS) has been employed to assess the composition of the atherosclerotic plaques in native coronary arteries. However, little is known about the detection of neoatherosclerosis by NIRS in in-stent restenosis (ISR). The aim of the study was to assess the relationship between the distribution of lipid determined by NIRS and morphology of ISR on optical coherence tomography (OCT).


RESULTS
We performed both NIRS and OCT in 39 drug-eluting stents with ISR. Values of lipid-core burden index (LCBI) derived by NIRS were compared with the OCT-derived thickness of the fibrous cap covering neoatherosclerotic lesions. A total of 22 (49%) in-stent neointimas were identified as lipid rich by both NIRS and OCT. There was good agreement between OCT and NIRS in identifying lipid within in-stent neointima (kappa = 0.60, 95% CI: 0.34-0.86). OCT identified thin-cap neoatheromas (TCNA) (<65 µm) in 12 stents (23%). The minimal cap thickness of in-stent neoatherosclerotic plaque measured by OCT correlated with the maxLCBI4mm (maximal LCBI per 4 mm) within the stent (r = -0.77, P< 0.01). Moreover, maxLCBI4mm was able to accurately predict TCNA with a cut-off value of >144.


CONCLUSIONS
NIRS correlates with OCT identification of lipids in stented vessels and is able to predict the presence of thin fibrous cap neoatheroma.
Center for Interventional Vascular Therapy, Division of Cardiology, New York Presbyterian Hospital and Columbia University, New York, NY, USA.|Cardiovascular Research Foundation, New York, NY, USA.|Third Division of Cardiology, Medical University of Silesia, Katowice, Poland.
Tomasz
T
Roleder
Center for Interventional Vascular Therapy, Division of Cardiology, New York Presbyterian Hospital and Columbia University, New York, NY, USA.
Keyvan
K
Karimi Galougahi
Center for Interventional Vascular Therapy, Division of Cardiology, New York Presbyterian Hospital and Columbia University, New York, NY, USA.|Cardiovascular Research Foundation, New York, NY, USA.
Chee Yang
CY
Chin
Center for Interventional Vascular Therapy, Division of Cardiology, New York Presbyterian Hospital and Columbia University, New York, NY, USA.
Navdeep K
NK
Bhatti
Dallas VA Medical Center, Dallas, TX, USA.
Emmanouil
E
Brilakis
Center for Interventional Vascular Therapy, Division of Cardiology, New York Presbyterian Hospital and Columbia University, New York, NY, USA.|Cardiovascular Research Foundation, New York, NY, USA.
Tamim M
TM
Nazif
Center for Interventional Vascular Therapy, Division of Cardiology, New York Presbyterian Hospital and Columbia University, New York, NY, USA.|Cardiovascular Research Foundation, New York, NY, USA.
Ajay J
AJ
Kirtane
Center for Interventional Vascular Therapy, Division of Cardiology, New York Presbyterian Hospital and Columbia University, New York, NY, USA.|Cardiovascular Research Foundation, New York, NY, USA.
Dimitri
D
Karmpaliotis
Third Division of Cardiology, Medical University of Silesia, Katowice, Poland.
Wojciech
W
Wojakowski
Center for Interventional Vascular Therapy, Division of Cardiology, New York Presbyterian Hospital and Columbia University, New York, NY, USA.|Cardiovascular Research Foundation, New York, NY, USA.
Martin B
MB
Leon
Cardiovascular Research Foundation, New York, NY, USA.
Gary S
GS
Mintz
Center for Interventional Vascular Therapy, Division of Cardiology, New York Presbyterian Hospital and Columbia University, New York, NY, USA.|Cardiovascular Research Foundation, New York, NY, USA.
Akiko
A
Maehara
Center for Interventional Vascular Therapy, Division of Cardiology, New York Presbyterian Hospital and Columbia University, New York, NY, USA.|Cardiovascular Research Foundation, New York, NY, USA.
Gregg W
GW
Stone
Center for Interventional Vascular Therapy, Division of Cardiology, New York Presbyterian Hospital and Columbia University, New York, NY, USA.|Cardiovascular Research Foundation, New York, NY, USA.
Ziad A
ZA
Ali
D000368:Aged; D000704:Analysis of Variance; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects* / Q000379:methods; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000401:mortality* / Q000628:therapy; D054855:Drug-Eluting Stents / Q000009:adverse effects*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D058426:Neointima / Q000000981:diagnostic imaging / Q000473:pathology; D015588:Observer Variation; D011237:Predictive Value of Tests; D011379:Prognosis; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D019265:Spectroscopy, Near-Infrared / Q000379:methods*; D016019:Survival Analysis; D041623:Tomography, Optical Coherence / Q000379:methods*; D016896:Treatment Outcome
in-stent restenosis; near-infrared spectroscopy; optical coherence tomography
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