Characteristics of early versus late in-stent restenosis in second-generation drug-eluting stents: an optical coherence tomography study.
OBJECTIVE
In-stent restenosis (ISR) is an important cause of drug-eluting stent (DES) failure and target vessel revascularisation. In this study we aimed to evaluate differences between early and late-presenting restenosis in second-generation DES using optical coherence tomography (OCT).


RESULTS
Overall, 171 cases of second-generation DES ISR with a follow-up OCT minimum lumen area <3.0 mm2 were included: 33.3% of patients (n=57) had early ISR, and 66.7% (n=114) had late ISR (duration from stent implantation >1 year). Minimum stent area (MSA) <4.0 mm2, neointimal thickness <100 µm, and heterogeneous neointimal hyperplasia (NIH) were more prevalent in early ISR, whereas NIH with neoatherosclerosis trended towards being more frequent for late ISR (28.9% vs. 15.8%, p=0.06). Multivariable analysis revealed that duration from implantation >2 years, absence of statin use, and NIH >50% were independent predictors for neoatherosclerosis (all p<0.05).


CONCLUSIONS
OCT morphological characteristics of second-generation DES ISR differ between early and late presentation. Early ISR was associated with MSA <4.0 mm2, while neoatherosclerosis contributed more commonly to late ISR.
Cardiovascular Research Foundation, New York, NY, USA.
Lei
L
Song
Gary S
GS
Mintz
Dong
D
Yin
Myong Hwa
MH
Yamamoto
Chee Yang
CY
Chin
Mitsuaki
M
Matsumura
Ajay J
AJ
Kirtane
Manish A
MA
Parikh
Jeffrey W
JW
Moses
Ziad A
ZA
Ali
Richard A
RA
Shlofmitz
Akiko
A
Maehara
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods; D023903:Coronary Restenosis / Q000000981:diagnostic imaging*; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D054855:Drug-Eluting Stents / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D058426:Neointima / Q000000981:diagnostic imaging; D013997:Time Factors; D041623:Tomography, Optical Coherence / Q000379:methods