Evaluation of neointimal morphology of lesions with or without in-stent restenosis: An optical coherence tomography study

Sung Joo Lee, Byeong Keuk Kim, Jung Sun Kim, Young Guk Ko, Donghoon Choi, Yangsoo Jang, Myeongki Hong

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

Background: Characterization of neointimal tissue is essential to understand the pathophysiology of in-stent restenosis (ISR) after drug-eluting stent (DES) implantation. Using optical coherence tomography (OCT), we compared the morphologic characteristics of in-stent neointimal tissue from 33 ISR lesions with those of 192 non-ISR lesions after DES implantation. Hypothesis: We hypothesized that the morphologic characteristics of in-stent neointimal tissue from ISR lesions were different from those of non-ISR lesions after DES implantation. Methods: The DES were coated with sirolimus (n=52), paclitaxel (n=57), zotarolimus (n=84), or everolimus (n=32). In-stent restenosis was defined as ≥50% diameter stenosis at the follow-up angiogram. Lesions with ≥10% neointimal burden ([neointima area × 100]/[stent area]), as determined by OCT, were included in this study. A follow-up OCT (mean follow-up duration, 12.0 ± 10.5 mo) was performed in 209 patients with 225 lesions (ISR lesions, n=33; non-ISR lesions, n=192). Qualitative OCT was used to assess tissue structure, backscatter, visible microvessels, and presence of intraluminal material. Results: The following characteristics were more common in ISR lesions than in non-ISR lesions: heterogeneous or layered tissues (78.8% vs 22.9%, P<0.001), low backscatter (60.6% vs 20.8%, P<0.001), and microvessels (48.5% vs 5.7%, P<0.001). The independent predictors for heterogeneous or layered neointimal tissues were increased neointima burden (odds ratio [OR]: 1.218, 95% confidence interval [CI]: 1.096-1.354, P<0.001), lumen area (OR: 4.672, 95% CI: 1.371-15.914, P = 0.014), and hypertension (OR: 0.415, 95% CI: 0.186-0.926, P = 0.032). Conclusions: This follow-up OCT study demonstrated that morphologic characteristics of neointimal tissues of ISR lesions differ from those of non-ISR lesions.

Original languageEnglish
Pages (from-to)633-639
Number of pages7
JournalClinical Cardiology
Volume34
Issue number10
DOIs
Publication statusPublished - 2011 Oct 1

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Optical Coherence Tomography
Stents
Drug-Eluting Stents
Neointima
Odds Ratio
Confidence Intervals
Microvessels
Sirolimus
Paclitaxel
Angiography

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

@article{0aaf7cf6668c46309db9a8dccb0717bc,
title = "Evaluation of neointimal morphology of lesions with or without in-stent restenosis: An optical coherence tomography study",
abstract = "Background: Characterization of neointimal tissue is essential to understand the pathophysiology of in-stent restenosis (ISR) after drug-eluting stent (DES) implantation. Using optical coherence tomography (OCT), we compared the morphologic characteristics of in-stent neointimal tissue from 33 ISR lesions with those of 192 non-ISR lesions after DES implantation. Hypothesis: We hypothesized that the morphologic characteristics of in-stent neointimal tissue from ISR lesions were different from those of non-ISR lesions after DES implantation. Methods: The DES were coated with sirolimus (n=52), paclitaxel (n=57), zotarolimus (n=84), or everolimus (n=32). In-stent restenosis was defined as ≥50{\%} diameter stenosis at the follow-up angiogram. Lesions with ≥10{\%} neointimal burden ([neointima area × 100]/[stent area]), as determined by OCT, were included in this study. A follow-up OCT (mean follow-up duration, 12.0 ± 10.5 mo) was performed in 209 patients with 225 lesions (ISR lesions, n=33; non-ISR lesions, n=192). Qualitative OCT was used to assess tissue structure, backscatter, visible microvessels, and presence of intraluminal material. Results: The following characteristics were more common in ISR lesions than in non-ISR lesions: heterogeneous or layered tissues (78.8{\%} vs 22.9{\%}, P<0.001), low backscatter (60.6{\%} vs 20.8{\%}, P<0.001), and microvessels (48.5{\%} vs 5.7{\%}, P<0.001). The independent predictors for heterogeneous or layered neointimal tissues were increased neointima burden (odds ratio [OR]: 1.218, 95{\%} confidence interval [CI]: 1.096-1.354, P<0.001), lumen area (OR: 4.672, 95{\%} CI: 1.371-15.914, P = 0.014), and hypertension (OR: 0.415, 95{\%} CI: 0.186-0.926, P = 0.032). Conclusions: This follow-up OCT study demonstrated that morphologic characteristics of neointimal tissues of ISR lesions differ from those of non-ISR lesions.",
author = "Lee, {Sung Joo} and Kim, {Byeong Keuk} and Kim, {Jung Sun} and Ko, {Young Guk} and Donghoon Choi and Yangsoo Jang and Myeongki Hong",
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language = "English",
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Evaluation of neointimal morphology of lesions with or without in-stent restenosis : An optical coherence tomography study. / Lee, Sung Joo; Kim, Byeong Keuk; Kim, Jung Sun; Ko, Young Guk; Choi, Donghoon; Jang, Yangsoo; Hong, Myeongki.

In: Clinical Cardiology, Vol. 34, No. 10, 01.10.2011, p. 633-639.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Evaluation of neointimal morphology of lesions with or without in-stent restenosis

T2 - An optical coherence tomography study

AU - Lee, Sung Joo

AU - Kim, Byeong Keuk

AU - Kim, Jung Sun

AU - Ko, Young Guk

AU - Choi, Donghoon

AU - Jang, Yangsoo

AU - Hong, Myeongki

PY - 2011/10/1

Y1 - 2011/10/1

N2 - Background: Characterization of neointimal tissue is essential to understand the pathophysiology of in-stent restenosis (ISR) after drug-eluting stent (DES) implantation. Using optical coherence tomography (OCT), we compared the morphologic characteristics of in-stent neointimal tissue from 33 ISR lesions with those of 192 non-ISR lesions after DES implantation. Hypothesis: We hypothesized that the morphologic characteristics of in-stent neointimal tissue from ISR lesions were different from those of non-ISR lesions after DES implantation. Methods: The DES were coated with sirolimus (n=52), paclitaxel (n=57), zotarolimus (n=84), or everolimus (n=32). In-stent restenosis was defined as ≥50% diameter stenosis at the follow-up angiogram. Lesions with ≥10% neointimal burden ([neointima area × 100]/[stent area]), as determined by OCT, were included in this study. A follow-up OCT (mean follow-up duration, 12.0 ± 10.5 mo) was performed in 209 patients with 225 lesions (ISR lesions, n=33; non-ISR lesions, n=192). Qualitative OCT was used to assess tissue structure, backscatter, visible microvessels, and presence of intraluminal material. Results: The following characteristics were more common in ISR lesions than in non-ISR lesions: heterogeneous or layered tissues (78.8% vs 22.9%, P<0.001), low backscatter (60.6% vs 20.8%, P<0.001), and microvessels (48.5% vs 5.7%, P<0.001). The independent predictors for heterogeneous or layered neointimal tissues were increased neointima burden (odds ratio [OR]: 1.218, 95% confidence interval [CI]: 1.096-1.354, P<0.001), lumen area (OR: 4.672, 95% CI: 1.371-15.914, P = 0.014), and hypertension (OR: 0.415, 95% CI: 0.186-0.926, P = 0.032). Conclusions: This follow-up OCT study demonstrated that morphologic characteristics of neointimal tissues of ISR lesions differ from those of non-ISR lesions.

AB - Background: Characterization of neointimal tissue is essential to understand the pathophysiology of in-stent restenosis (ISR) after drug-eluting stent (DES) implantation. Using optical coherence tomography (OCT), we compared the morphologic characteristics of in-stent neointimal tissue from 33 ISR lesions with those of 192 non-ISR lesions after DES implantation. Hypothesis: We hypothesized that the morphologic characteristics of in-stent neointimal tissue from ISR lesions were different from those of non-ISR lesions after DES implantation. Methods: The DES were coated with sirolimus (n=52), paclitaxel (n=57), zotarolimus (n=84), or everolimus (n=32). In-stent restenosis was defined as ≥50% diameter stenosis at the follow-up angiogram. Lesions with ≥10% neointimal burden ([neointima area × 100]/[stent area]), as determined by OCT, were included in this study. A follow-up OCT (mean follow-up duration, 12.0 ± 10.5 mo) was performed in 209 patients with 225 lesions (ISR lesions, n=33; non-ISR lesions, n=192). Qualitative OCT was used to assess tissue structure, backscatter, visible microvessels, and presence of intraluminal material. Results: The following characteristics were more common in ISR lesions than in non-ISR lesions: heterogeneous or layered tissues (78.8% vs 22.9%, P<0.001), low backscatter (60.6% vs 20.8%, P<0.001), and microvessels (48.5% vs 5.7%, P<0.001). The independent predictors for heterogeneous or layered neointimal tissues were increased neointima burden (odds ratio [OR]: 1.218, 95% confidence interval [CI]: 1.096-1.354, P<0.001), lumen area (OR: 4.672, 95% CI: 1.371-15.914, P = 0.014), and hypertension (OR: 0.415, 95% CI: 0.186-0.926, P = 0.032). Conclusions: This follow-up OCT study demonstrated that morphologic characteristics of neointimal tissues of ISR lesions differ from those of non-ISR lesions.

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