Impact of coronary stent fracture on restenotic neointimal tissue characterization after drug-eluting stent implantation: An integrated backscatter intravascular ultrasound study

Yasuhiro Uchida, Satoshi Ichimiya, Hideki Ishii, Hideo Oishi, Toshijiro Aoki, Yusuke Miki, Toshiki Kawamiya, Hitoshi Ichimiya, Junji Watanabe, Masaaki Kanashiro, Shinji Hayano, Susumu Suzuki, Tetsuya Amano, Tatsuaki Matsubara, Toyoaki Murohara

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Abstract

Although drug-eluting stents (DESs) reduce the rates of in-stent restenosis (ISR) and subsequent target lesion revascularization, stent fracture (SF) after DES implantation has become an important concern because of its potential association with restenosis and stent thrombosis. We aimed to assess the pathogenic impact of SF on in-stent restenotic neointimal tissue components after DES implantation. We analyzed 43 consecutive patients (14 with SF and 29 without SF) with ISR requiring revascularization after DES implantation between January 2008 and March 2014. For evaluation of in-stent tissue components, integrated backscatter intravascular ultrasound (IB-IVUS) was performed. SF was defined as complete or partial separation of stent segments observed using plain fluoroscopy or intravascular ultrasound. On volumetric IB-IVUS analyses, patients with SF had a significantly higher percentage of lipid tissue volume within the neointima and a significantly lower percentage of fibrous tissue volume than those without (37.3 ± 18.9% versus 24.9 ± 12.4%, P = 0.02, and 61.2 ± 18.3 versus 72.6 ± 12.1%, P = 0.04, respectively). Moreover, SF was positively correlated with the percentage of lipid volume on multiple linear regression analysis after adjustment for confounding factors (β = 0.36, P = 0.03). The interval from stent implantation was similar in both groups (47.0 ± 28.7 versus 37.7 ± 33.3 months; P = 0.39). In conclusion, SF is associated with larger lipid tissue volume within the neointima after DES placement, suggesting a contribution to the development of neoatherosclerosis and vulnerable neointima. Thus SF might lead to future adverse coronary events.

Original languageEnglish
Pages (from-to)861-867
Number of pages7
JournalInternational heart journal
Volume58
Issue number6
DOIs
Publication statusPublished - 01-01-2017
Externally publishedYes

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

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    Uchida, Y., Ichimiya, S., Ishii, H., Oishi, H., Aoki, T., Miki, Y., Kawamiya, T., Ichimiya, H., Watanabe, J., Kanashiro, M., Hayano, S., Suzuki, S., Amano, T., Matsubara, T., & Murohara, T. (2017). Impact of coronary stent fracture on restenotic neointimal tissue characterization after drug-eluting stent implantation: An integrated backscatter intravascular ultrasound study. International heart journal, 58(6), 861-867. https://doi.org/10.1536/ihj.16-571