nach oben

Erschienen in:

19.02.2019 | Original Paper

Qualitative and quantitative neointimal characterization by optical coherence tomography in patients presenting with in-stent restenosis

verfasst von: Erion Xhepa, Robert A. Byrne, Fernando Rivero, Andi Rroku, Javier Cuesta, Gjin Ndrepepa, Sebastian Kufner, Teresa Bastante Valiente, Salvatore Cassese, Marcos Garcia-Guimaraes, Anna Lena Lahmann, Himanshu Rai, Heribert Schunkert, Michael Joner, María José Pérez-Vizcayno, Nieves Gonzalo, Fernando Alfonso, Adnan Kastrati

Erschienen in: Clinical Research in Cardiology | Ausgabe 9/2019

Einloggen, um Zugang zu erhalten

Abstract

Aims

To describe optical coherence tomography (OCT) findings in patients with in-stent restenosis (ISR) and determine predictors of neointimal patterns and neoatherosclerosis.

Methods and results

Patients undergoing OCT prior to PCI for ISR in three European centres were included. Analyses were performed in a core laboratory. Qualitative and quantitative [gray-scale signal intensity (GSI)] neointima analyses were performed on a per quadrant basis. A total of 107 patients were included. Predominantly homogeneous lesions included 4.5% (0.0–14.3) non-homogeneous quadrants, while predominantly non-homogeneous ones included 28.1% (20.3–37.5) homogeneous quadrants. Mean GSI values differed significantly between homogeneous [108.4 (92.5–123.6)], non-homogeneous [79.9 (61.2–95.9)], and neoatherosclerosis [88.3 (72.8–104.9)] quadrants (p < 0.001 for all comparisons). Stent underexpansion was observed in 48.5% and 61.1% of lesions, respectively (p = 0.225). Female sex and maximal neointimal thickness independently correlate with a non-homogeneous pattern, while angiographic pattern and diabetes mellitus inversely correlate with such pattern. Time from index stenting procedure was the only independent predictor of neoatherosclerosis.

Conclusions

Different neointimal patterns coexist in a significant proportion of ISR lesions. GSI values differ significantly between neointimal categories. Neoatherosclerosis is a time-dependent phenomenon, displaying different time courses in DES compared to BMS, with earlier appearance in the former group. Stent underexpansion is a frequent finding in patients with ISR.

Nur mit Berechtigung zugänglich

Cassese S, Byrne RA, Tada T, Pinieck S, Joner M, Ibrahim T, King LA, Fusaro M, Laugwitz KL, Kastrati A (2014) Incidence and predictors of restenosis after coronary stenting in 10 004 patients with surveillance angiography. Heart 100(2):153–159. https://doi.org/10.1136/heartjnl-2013-304933 CrossRefPubMed

Werner N, Nickenig G, Sinning JM (2018) Complex PCI procedures: challenges for the interventional cardiologist. Clin Res Cardiol 107(Suppl 2):64–73. https://doi.org/10.1007/s00392-018-1316-1 CrossRefPubMed

Gonzalo N, Serruys PW, Okamura T, van Beusekom HM, Garcia-Garcia HM, van Soest G, van der Giessen W, Regar E (2009) Optical coherence tomography patterns of stent restenosis. Am Heart J 158(2):284–293. https://doi.org/10.1016/j.ahj.2009.06.004 CrossRefPubMed

Kufner S, Xhepa E, Lutter C, Cassese S, Joner M (2017) Optical coherence tomography in drugeluting stent restenosis: a technique in need of a strategy. Minerva Cardioangiol 65(1):61–67. https://doi.org/10.23736/S0026-4725.16.04241-9 CrossRefPubMed

Lutter C, Mori H, Yahagi K, Ladich E, Joner M, Kutys R, Fowler D, Romero M, Narula J, Virmani R, Finn AV (2016) Histopathological differential diagnosis of optical coherence tomographic image interpretation after stenting. JACC Cardiovasc Interv 9(24):2511–2523. https://doi.org/10.1016/j.jcin.2016.09.016 CrossRefPubMed

Joner M, Finn AV, Farb A, Mont EK, Kolodgie FD, Ladich E, Kutys R, Skorija K, Gold HK, Virmani R (2006) Pathology of drug-eluting stents in humans: delayed healing and late thrombotic risk. J Am Coll Cardiol 48(1):193–202. https://doi.org/10.1016/j.jacc.2006.03.042 CrossRefPubMed

Nakano M, Otsuka F, Yahagi K, Sakakura K, Kutys R, Ladich ER, Finn AV, Kolodgie FD, Virmani R (2013) Human autopsy study of drug-eluting stents restenosis: histomorphological predictors and neointimal characteristics. Eur Heart J 34(42):3304–3313. https://doi.org/10.1093/eurheartj/eht241 CrossRefPubMedPubMedCentral

Habara M, Terashima M, Nasu K, Kaneda H, Inoue K, Ito T, Kamikawa S, Kurita T, Tanaka N, Kimura M, Kinoshita Y, Tsuchikane E, Matsuo H, Ueno K, Katoh O, Suzuki T (2011) Difference of tissue characteristics between early and very late restenosis lesions after bare-metal stent implantation: an optical coherence tomography study. Circ Cardiovasc Interv 4(3):232–238. https://doi.org/10.1161/CIRCINTERVENTIONS.110.959999 CrossRefPubMed

Goto K, Takebayashi H, Kihara Y, Hagikura A, Fujiwara Y, Kikuta Y, Sato K, Kodama S, Taniguchi M, Hiramatsu S, Haruta S (2013) Appearance of neointima according to stent type and restenotic phase: analysis by optical coherence tomography. EuroIntervention 9(5):601–607. https://doi.org/10.4244/EIJV9I5A96 CrossRefPubMed

10.

Song L, Mintz GS, Yin D, Yamamoto MH, Chin CY, Matsumura M, Kirtane AJ, Parikh MA, Moses JW, Ali ZA, Shlofmitz RA, Maehara A (2017) Characteristics of early versus late in-stent restenosis in second-generation drug-eluting stents: an optical coherence tomography study. EuroIntervention. https://doi.org/10.4244/EIJ-D-16-00787 CrossRefPubMed

11.

Mehran R, Dangas G, Abizaid AS, Mintz GS, Lansky AJ, Satler LF, Pichard AD, Kent KM, Stone GW, Leon MB (1999) Angiographic patterns of in-stent restenosis: classification and implications for long-term outcome. Circulation 100(18):1872–1878CrossRefPubMed

12.

Otsuka F, Byrne RA, Yahagi K, Mori H, Ladich E, Fowler DR, Kutys R, Xhepa E, Kastrati A, Virmani R, Joner M (2015) Neoatherosclerosis: overview of histopathologic findings and implications for intravascular imaging assessment. Eur Heart J 36(32):2147–2159. https://doi.org/10.1093/eurheartj/ehv205 CrossRefPubMed

13.

Malle C, Tada T, Steigerwald K, Ughi GJ, Schuster T, Nakano M, Massberg S, Jehle J, Guagliumi G, Kastrati A, Virmani R, Byrne RA, Joner M (2013) Tissue characterization after drug-eluting stent implantation using optical coherence tomography. Arterioscler Thromb Vasc Biol 33(6):1376–1383. https://doi.org/10.1161/ATVBAHA.113.301227 CrossRefPubMed

14.

Koppara T, Tada T, Xhepa E, Kufner S, Byrne RA, Ibrahim T, Laugwitz KL, Kastrati A, Joner M (2018) Randomised comparison of vascular response to biodegradable polymer sirolimus eluting and permanent polymer everolimus eluting stents: an optical coherence tomography study. Int J Cardiol 258:42–49. https://doi.org/10.1016/j.ijcard.2018.01.011 CrossRefPubMed

15.

Tibshirani R (1997) The lasso method for variable selection in the Cox model. Stat Med 16(4):385–395CrossRefPubMed

16.

Alfonso F, Byrne RA, Rivero F, Kastrati A (2014) Current treatment of in-stent restenosis. J Am Coll Cardiol 63(24):2659–2673. https://doi.org/10.1016/j.jacc.2014.02.545 CrossRefPubMed

17.

Colleran R, Kastrati A (2018) Percutaneous coronary intervention: balloons, stents and scaffolds. Clin Res Cardiol 107(Suppl 2):55–63. https://doi.org/10.1007/s00392-018-1328-x CrossRefPubMed

18.

Tada T, Kadota K, Hosogi S, Miyake K, Ohya M, Amano H, Izawa Y, Kanazawa T, Kubo S, Ichinohe T, Hyoudou Y, Hayakawa Y, Sabbah MM, Otsuru S, Hasegawa D, Habara S, Tanaka H, Fuku Y, Katoh H, Goto T, Mitsudo K (2015) Association between tissue characteristics assessed with optical coherence tomography and mid-term results after percutaneous coronary intervention for in-stent restenosis lesions: a comparison between balloon angioplasty, paclitaxel-coated balloon dilatation, and drug-eluting stent implantation. Eur Heart J Cardiovasc Imaging 16(10):1101–1111. https://doi.org/10.1093/ehjci/jev031 CrossRefPubMed

19.

Sakakura K, Joner M, Virmani R (2014) Does neointimal characterization following DES implantation predict long-term outcomes? JACC Cardiovasc Imaging 7(8):796–798. https://doi.org/10.1016/j.jcmg.2014.06.002 CrossRefPubMed

20.

Rheude TA, Xhepa E, Byrne RA (2017) Markedly different tissue types on optical coherence tomography imaging in a patient with multiple lesion drug-eluting stent in-stent restenosis. Catheter Cardiovasc Interv 89(6):E181–E184. https://doi.org/10.1002/ccd.26694 CrossRefPubMed

21.

Adriaenssens T, Joner M, Godschalk TC, Malik N, Alfonso F, Xhepa E, De Cock D, Komukai K, Tada T, Cuesta J, Sirbu V, Feldman LJ, Neumann FJ, Goodall AH, Heestermans T, Buysschaert I, Hlinomaz O, Belmans A, Desmet W, Ten Berg JM, Gershlick AH, Massberg S, Kastrati A, Guagliumi G, Byrne RA (2017) Prevention of late stent thrombosis by an interdisciplinary global european effort. Optical coherence tomography findings in patients with coronary stent thrombosis: a report of the PRESTIGE consortium (prevention of late stent thrombosis by an interdisciplinary global european effort). Circulation 136(11):1007–1021. https://doi.org/10.1161/CIRCULATIONAHA.117.026788 CrossRefPubMedPubMedCentral

22.

Alfonso F, Fernandez-Vina F, Medina M, Hernandez R (2013) Neoatherosclerosis: the missing link between very late stent thrombosis and very late in-stent restenosis. J Am Coll Cardiol 61(12):e155. https://doi.org/10.1016/j.jacc.2012.09.071 CrossRefPubMed

23.

Otsuka F, Vorpahl M, Nakano M, Foerst J, Newell JB, Sakakura K, Kutys R, Ladich E, Finn AV, Kolodgie FD, Virmani R (2014) Pathology of second-generation everolimus-eluting stents versus first-generation sirolimus- and paclitaxel-eluting stents in humans. Circulation 129(2):211–223. https://doi.org/10.1161/CIRCULATIONAHA.113.001790 CrossRefPubMed

24.

Nakazawa G, Otsuka F, Nakano M, Vorpahl M, Yazdani SK, Ladich E, Kolodgie FD, Finn AV, Virmani R (2011) The pathology of neoatherosclerosis in human coronary implants bare-metal and drug-eluting stents. J Am Coll Cardiol 57(11):1314–1322. https://doi.org/10.1016/j.jacc.2011.01.011 CrossRefPubMedPubMedCentral

25.

Miura K, Tada T, Habara S, Kuwayama A, Shimada T, Ohya M, Murai R, Amano H, Kubo S, Otsuru S, Tanaka H, Fuku Y, Goto T, Kadota K (2018) Optical coherence tomography predictors for recurrent restenosis after paclitaxel-coated balloon angioplasty for drug-eluting stent restenosis. Circ J. https://doi.org/10.1253/circj.CJ-18-0464 CrossRefPubMedPubMedCentral

Titel: Qualitative and quantitative neointimal characterization by optical coherence tomography in patients presenting with in-stent restenosis
verfasst von: Erion Xhepa
Robert A. Byrne
Fernando Rivero
Andi Rroku
Javier Cuesta
Gjin Ndrepepa
Sebastian Kufner
Teresa Bastante Valiente
Salvatore Cassese
Marcos Garcia-Guimaraes
Anna Lena Lahmann
Himanshu Rai
Heribert Schunkert
Michael Joner
María José Pérez-Vizcayno
Nieves Gonzalo
Fernando Alfonso
Adnan Kastrati
Publikationsdatum: 19.02.2019
Verlag: Springer Berlin Heidelberg
Erschienen in: Clinical Research in Cardiology / Ausgabe 9/2019
Print ISSN: 1861-0684
Elektronische ISSN: 1861-0692
DOI: https://doi.org/10.1007/s00392-019-01439-5

Update Kardiologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Klimawandel und Gesundheit: Was Sie in der Hausarztpraxis wissen müssen und tun können

Springer Medizin

Qualitative and quantitative neointimal characterization by optical coherence tomography in patients presenting with in-stent restenosis

Abstract

Aims

Methods and results

Conclusions

Neu im Fachgebiet Kardiologie

Vorsicht, erhöhte Blutungsgefahr nach PCI!

Triglyzeridsenker schützt nicht nur Hochrisikopatienten

Gibt es eine Wende bei den bioresorbierbaren Gefäßstützen?

Darf man die Behandlung eines Neonazis ablehnen?

Update Kardiologie

Klimawandel und Gesundheit: Was Sie in der Hausarztpraxis wissen müssen und tun können

Springer Medizin

Abstract

Aims

Methods and results

Conclusions

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 9/2019

Impact of single-visit American versus European office blood pressure measurement procedure on individual blood pressure classification: a cross-sectional study

Left atrial anterior line ablation using ablation index and inter-lesion distance measurement

Atrial high rate episodes in patients with cardiac implantable electronic devices: implications for clinical outcomes

Haemodynamic prosthetic valve performance in patients with early leaflet thrombosis after transcatheter aortic valve implantation

Uptake in antithrombotic treatment and its association with stroke incidence in atrial fibrillation: insights from a large German claims database

Relation of lowering door-to-balloon time and mortality in ST segment elevation myocardial infarction patients undergoing percutaneous coronary intervention

Neu im Fachgebiet Kardiologie

Vorsicht, erhöhte Blutungsgefahr nach PCI!

Triglyzeridsenker schützt nicht nur Hochrisikopatienten

Gibt es eine Wende bei den bioresorbierbaren Gefäßstützen?

Darf man die Behandlung eines Neonazis ablehnen?

Update Kardiologie