Clin Res Cardiol (2022). https://doi.org/10.1007/s00392-022-02002-5

Optical Coherence Tomography–Based Characterization of Neointimal Atherosclerotic Changes in Patients Presenting With Very Late Stent Thrombosis or In-Stent Restenosis
A. Aytekin1, P. Nicol1, M. Seguchi1, F. Alfonso2, T. Adriaenssens3, N. Nano1, L. J. Feldman4, F.-J. Neumann5, A. H. Goodall6, T. Heestermans7, D. C. Pin Yin8, I. Buysschaert9, O. Hlinomaz10, W. Desmet3, J. Ten Berg8, S. Massberg11, G. Guagliumi12, R. Byrne13, M. Joner1, A. Kastrati1, E. Xhepa1
1Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, München; 2Hospital Universitario de La Princesa, Madrid, ES; 3Department of Cardiovascular Sciences, University Hospitals Leuven, Leuven, BE; 4Departement de Cardiologie, AP-HP, DHU FIRE, U-1148 INSERM, Hopital Bichat, Paris, FR; 5Klinik für Kardiologie und Angiologie II, Universitäts-Herzzentrum Freiburg / Bad Krozingen, Bad Krozingen; 6Department of Cardiovascular Sciences, University of Leicester & Leicester NIHR Cardiovascular Biomedical Research Unit, Glenfield Hospital, Leicester, UK; 7Department of Cardiology, Noordwest Ziekenhuisgroep, Alkmaar, NL; 8St. Antonius Hospital, Nieuwegein, NL; 9Antwerp Cardiovascular Institute, ZNA Middelheim, Antwerpen, BE; 10ICRC, St. Anne University Hospital, Brno, CZ; 11Medizinische Klinik und Poliklinik I, LMU Klinikum der Universität München, München; 12Ospedale Papa Giovanni XXIII, Bergamo, IT; 13Mater Private Dublin, Dublin 7, IE;

Background

Neoatherosclerosis has been associated with the occurrence of both in-stent restenosis (ISR) and very late stent thrombosis (VLST). A detailed comparison of the prevalence and characteristics of neointimal changes between these manifestations of stent failure has not yet been performed. The aim of the present study was to describe and compare the neoatherosclerotic changes in patients with VLST and ISR using optical coherence tomography.

Methods

Patients with VLST from the PRESTIGE (Prevention of Late Stent Thrombosis by an Interdisciplinary Global European Effort) registry and patients with ISR from the German Heart Centre Munich database were matched on the basis of stent type and time from index stenting procedure, as both factors have been shown to have a significant impact on the development of neoatherosclerosis. Forty-nine patients with VLST and 68 patients with ISR were included in this analysis. Neoatherosclerosis was defined as presence of 1 or more of the following: foam cell infiltration, thick-cap or thin-cap fibroatheroma, and neointimal calcification.

Results

Patients presenting with ISR had significantly higher neointimal area (1.39 mm2 [0.76-2.28 mm2] vs 0.79 mm2 [0.20-1.86 mm2]; P=0.004). Overall, the ISR group showed a significantly higher prevalence of neoatherosclerotic changes (20.0% vs 8.3%; P<0.001). This finding was driven mainly by significantly higher foam cell infiltration (18.4% vs 4.0%; P<0.001) as well as a tendency toward a higher prevalence of fibroatheroma (5.3% vs 1.2%; P=0.070) in patients with ISR, while neointimal calcification (2.1% vs 3.3%; P=0.779) was not significantly different between the groups.

Conclusion

The prevalence of neoatherosclerosis is non-negligible in both patients with VLST and those with ISR. Overall, neoatherosclerotic changes were significantly higher in the ISR group and were driven mainly by significantly higher foam cell infiltration as well as a tendency toward a higher prevalence of fibroatheroma.


https://dgk.org/kongress_programme/jt2022/aP1225.html