Appearance of Lipid-Laden Intima and Neovascularization After Implantation of Bare-Metal Stents

OBJECTIVES: We examined the neointimal characteristics of bare-metal stents (BMS) in extended late phase by the use of optical coherence tomography (OCT). The long-term neointimal features after BMS implantation have not yet been fully characterized.

METHODS: Intracoronary OCT observation of BMS segments was performed during the early phase (<6 months, n = 20) and late phase (>5 years, n = 21) after implantation. Internal tissue of the BMS was categorized into normal neointima, characterized by a signal-rich band without signal attenuation, or lipid-leaden intima, with marked signal attenuation and a diffuse border. In addition, the presence of disrupted intima and thrombus was evaluated. Neovascularization was defined as small vesicular or tubular structures, and the location of the microvessels was classified into peristent or intraintima.

RESULTS: Normal neointima proliferated homogeneously, and lipid-laden intima was not observed in the early phase. In the late phase, lipid-laden intima, intimal disruption, and thrombus frequently were found in comparison with the early phase (67% vs. 0%, 38% vs. 0%, and 52% vs. 5%, respectively; p < 0.05). Peristent neovascularization demonstrated a similar incidence between the 2 phases. The appearance of intraintima neovascularization was more prevalent in the late phase than the early phase (62% vs. 0%, respectively; p < 0.01) and in segments with lipid-laden intima than in nonlipidic segments (79% vs. 29%, respectively; p = 0.026).

CONCLUSIONS: This OCT study suggests that neointima within the BMS often transforms into lipid-laden tissue during an extended period of time and that expansion of neovascularization from peristent to intraintima contributes to atherosclerotic progression of neointima.  Sam Shields Womens Jersey

PMID:

Posted in Invasive Imaging and tagged , , .

2 Comments

  1. See also post from November 17:
    Intracoronary Optical Coherence Tomography: A Comprehensive Review.
    Bezerra HG, Costa MA, Guagliumi G, Rollins AM, Simon DI.
    J Am Coll Cardiol Intv. 2009; 2(11):1035-1046.

  2. Another interesting article by the same authors looks at neointimal tissue growth, but with modern drug-eluting stents.

    Advanced neointimal growth is not associated with a low risk of in-stent thrombus. Optical coherence tomographic findings after first-generation drug-eluting stent implantation.
    Murakami D, Takano M, Yamamoto M, Inami S, Ohba T, Seino Y, Mizuno K.
    Circ J. 2009 Sep;73(9):1627-34.
    PMID:

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