8 March 2013 In-stent neoatherosclerosis: are first generation drug eluting stents different than bare metal stents? An optical coherence tomography study
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Abstract
Purpose: In-stent neoatherosclerosis has been recognised in pathologic specimens of bare metal stents (BMS), and recently in first generation drug eluting stents (1st-DES), as well. However, in vivo data are scarce. By optical coherence tomography, we investigated the incidence and morphological characteristics of neoatherosclerosis (NA) very late after BMS or 1st-DES implantation. Methods: From 1/1/2007 to 31/1/2012, 52 patients from two institutions underwent >24 months follow-up OCT assessment of a BMS or a 1st-DES (13 BMS – 39 1st-DES). NA was characterized using criteria for native atherosclerosis. Results: BMS had longer follow-up interval but no differences in clinical presentation at follow-up. No significant differences were evident in the incidence of NA, neointimal rupture, lipid content, neovascularization or macrophage infiltration between BMS and 1st-DES. There was however a trend for lower fibrous cap thickness (FCT) and for higher calcification in BMS (FCT: 51±31 μm vs. 92±59 μm, p=0.057; calcifications: 46.2% vs. 15.4%, p=0.051). 1st-DES with neoatherosclerosis had longer interval from implantation compared to 1st-DES with homogeneous coverage [Median 71 months (range 25-130) vs. 57 months (24-68), p<0.05], but there was no difference for BMS with or without neoatherosclerosis [Median 125 months (range 90-201) vs. 168 months (132-168), p=0.63]. Conclusions: The incidence and morphological characteristics of NA are similar between 1st-DES and BMS of more prolonged follow-up. Our findings suggest a time-dependent pattern in the incidence of NA in 1st-DES with 2-11 years follow-up.
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Antonios Karanasos, Antonios Karanasos, Karen Witberg, Karen Witberg, Jurgen Ligthart, Jurgen Ligthart, Konstantinos Toutouzas, Konstantinos Toutouzas, Joost Daemen, Joost Daemen, Gijs van Soest, Gijs van Soest, Muthukaruppan Gnanadesigan, Muthukaruppan Gnanadesigan, Nicholas van Mieghem, Nicholas van Mieghem, Felix Zijlstra, Felix Zijlstra, Evelyn Regar, Evelyn Regar, } "In-stent neoatherosclerosis: are first generation drug eluting stents different than bare metal stents? An optical coherence tomography study", Proc. SPIE 8565, Photonic Therapeutics and Diagnostics IX, 856543 (8 March 2013); doi: 10.1117/12.2006341; https://doi.org/10.1117/12.2006341
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