Optical coherence tomography in differential diagnosis of the morphology of in-stent restenosis and neoaterosclerosis
https://doi.org/10.15829/1728-8800-2020-2501
Abstract
In spite of widespread use of coronary stents for the treatment of coronary artery disease (CAD), the recurrence of ischemia in the long-term period is still serious limitation of percutaneous coronary interventions. Recurrence of the CAD symptoms in the first year after the intervention is most often due to in-stent restenosis, which is mainly observed after implantation of bare-metal stents. The implantation of a drug-eluting stent effectively suppresses the smooth muscle proliferation underlying the restenosis. Nevertheless, drug-eluting stents can become a site for neoatherosclerosis in the long term due to inflammatory and allergic reactions. Differential diagnosis of these morphological processes using conventional coronary angiography is difficult. Novel methods of intravascular imaging, in particular, optical coherence tomography, provide intravital visualization of pathological processes in stent, which is presented in a current case report.
About the Authors
V. N. Fomin
S.P. Botkin State Clinical Hospital
Russian Federation
Russian Federation
Moscow
B. A. Rudenko
National Medical Research Center for Preventive Medicine
Russian Federation
Russian Federation
Moscow
A. S. Shanoyan
National Medical Research Center for Preventive Medicine
Russian Federation
Russian Federation
Moscow
D. K. Vasiliev
https://www.gnicpm.ru/Employee/1002
National Medical Research Center for Preventive Medicine
Russian Federation
National Medical Research Center for Preventive Medicine
Russian Federation
Moscow
O. M. Drapkina
National Medical Research Center for Preventive Medicine
Moscow
References
1. Muramatsu T, Onuma Y, Zhang YJ, et al. Progress in treatment by percutaneous coronary intervention: the stent of the future. Rev Esp Cardiol. 2013; 66(6):483-96. doi: 10.1016/j.rec.2012.12.009.
2. Nakamura D, Yasumura K, Nakamura H, et al. Different neoatherosclerosis patterns in drug-eluting- and bare-metal stent restenosis — optical coherence tomography study. Circ J. 2019;83(2):313-9. doi:10.1253/circj.CJ-18-0701.
3. Yahagi K, Kolodgie FD, Otsuka F, et al. Pathophysiology of native coronary, vein graft, and in-stent atherosclerosis. Nat Rev Cardiol. 2016;13:79-98. doi:10.1038/nrcardio.2015.164.
4. Mazin I, Paul G, Asher E. Neoatherosclerosis — From basic concept to clinical implication. Thromb Res. 2019;178:12-6. doi:10.1016/j.thromres.2019.03.016.
5. Shlofmitz E, Iantorno M, Waksman R. Restenosis of drug-eluting stents. Circ Cardiovasc Interv. 2019;12:e007023. doi: 10.1161/circinterventions.118.007023.
6. Cui Y, Liu Y, Zhao F, et al. Neoatherosclerosis after drug-eluting stent implantation: roles and mechanisms. Oxid Med Cell Longev. 2016;2016:5924234. doi:10.1155/2016/5924234.
7. Park SJ, Kang SJ, Virmani R, et al. In-stent Neoatherosclerosis. A final common pathway of late stent failure. JACC 2012;59(23):2051. doi:10.1016/j.jacc.2011.10.909.
8. Komiyama H, Takano M, Hata N, et al. Neoatherosclerosis: Coronary stents seal atherosclerotic lesions but result in making a new problem of atherosclerosis. World J Cardiol. 2015;7(11):776-83. doi:10.4330/wjc.v7.i11.776.
9. Xhepa E, Byrne RA, Rivero F, et al. Qualitative and quantitative neointimal characterization by optical coherence tomography in patients presenting with in-stent restenosis. Clin Res Cardiol. 2019;108(9):1059-68. doi:10.1007/s00392-019-01439-5.
10. Otsuka F, Byrne RA, Yahagi K, et al. Neoatherosclerosis: overview of histopathologic findings and implications for intravascular imaging assessment. Eur Heart J. 2015;36(32):2147-59. doi:10.1093/eurheartj/ehv205.
11. Buccheri D, Piraino D, Andolina G, et al. Understanding and managing in-stent restenosis: a review of clinical data, from pathogenesis to treatment. J Thorac Dis. 2016;8(10):E1150-62. doi:10.21037/jtd.2016.10.93.
12. Komkov AA, Mazaev VP, Ryazanova SV. Neoatherosclerosis in the stent. Rational Pharmacotherapy in Cardiology. 2015;11(6):626-33. (In Russ.)
Review
For citations:
Fomin V.N., Rudenko B.A., Shanoyan A.S., Vasiliev D.K., Drapkina O.M. Optical coherence tomography in differential diagnosis of the morphology of in-stent restenosis and neoaterosclerosis. Cardiovascular Therapy and Prevention. 2020;19(5):2501. (In Russ.) https://doi.org/10.15829/1728-8800-2020-2501
Views:
532
Email this article 
