Late Stent Evaluation (Neoatherosclerosis)
Using light instead of ultrasound, optical coherence tomography (OCT) can provide high-resolution in vivo images of the coronary artery and evaluate the stent status and neointimal tissue after coronary stent implantation more accurately than intravascula
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Jung-Hee Lee, Yangsoo Jang, and Jung-Sun Kim
Using light instead of ultrasound, optical coherence tomography (OCT) can provide high- resolution in vivo images of the coronary artery and evaluate the stent status and neointimal tissue after coronary stent implantation more accurately than intravascular ultrasound (IVUS). Intravascular OCT assessment is useful for the detection of strut coverage, malapposition, and the characterization of neointimal tissue during stent follow-up due to high resolution. Furthermore, OCT enables detailed assessment of the morphological characteristics of late stent failure, including neoatherosclerosis. In this chapter, late stent-based changes evaluated by OCT will be reviewed.
17.1 Stent Strut Coverage Percutaneous coronary intervention is currently the standard treatment for symptomatic coronary artery disease [1], and drug-eluting stent (DES) has
J.-H. Lee Division of Cardiology, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu, South Korea Y. Jang • J.-S. Kim (*) Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea e-mail: [email protected] © Springer Nature Singapore Pte Ltd. 2018 M.-K. Hong (ed.), Coronary Imaging and Physiology, https://doi.org/10.1007/978-981-10-2787-1_17
minimized the limitation of bare metal stent (BMS) [2, 3]. However, delayed stent strut coverage following DES implantation is considered as one of the crucial pathological mechanism of late stent thrombosis [4]. Neointimal formation is a common feature of healing response after stent implantation that occurs in vascular tissue [5]. It is well recognized that neointimal coverage after BMS implantation requires around 1 month and excessive neointimal formation results in in-stent restenosis (ISR) [6]. Several OCT studies showed that almost complete stent strut coverage was observed in BMS treated lesion in both the early and late periods [7–10]. DES remarkably reduced the rate of ISR and subsequent target lesion revascularization (TLR) by releasing drugs that can inhibit neointimal growth [2, 3]. However, excessive inhibition of neointimal formation and the vascular inflammatory response caused delayed vascular healing process with incomplete endothelialization, which has been associated with an increased risk of late stent thrombosis (LST) [11, 12]. Representative OCT images of late stent thrombosis within incomplete endothelialization of struts are shown in Fig. 17.1. There are many observational OCT studies about the rate of stent strut coverage of various DES and BMS in each period after stent implantation (Table 17.1) [7–10, 13–23]. Some studies evaluated neointimal coverage according to initial clinical presentation, such as acute coronary syndrome (ACS) and non-ACS, and suggested that strut coverage might be associated with initial clinical presentation (Table 17.2) [7, 9, 22, 24–27] 165
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Fig. 17.1 Representative optical coherence tomography (OCT) images of late stent throm
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