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Neointima and neoatherosclerotic characteristics in bare metal and first- and second-generation drug-eluting stents in patients admitted with cardiovascular events attributed to stent failure: an optical coherence tomography study

1. Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom; 2. Leiden University Medical Centre, Leiden, the Netherlands; 3. Department of Cardiology, Bern University Hospital, Bern, Switzerland; 4. Department of Mechanical Engineering, University College London, London, United Kingdom; 5. Nanjing First Hospital, Nanjing Medical University, Nanjing, China; 6. Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands; 7. Faculty of Medicine, National Heart & Lung Institute, Imperial College London, London, United Kingdom; 8. Institute of Cardiovascular Sciences, University College London, London, United Kingdom

Aims: The aim of this study was to assess neoatherosclerotic plaque morphology in bare metal (BMS) and first- and second-generation drug-eluting stents (DES) in patients presenting with an event attributed to stent failure.

Methods and results: Thirty-five patients (11 implanted with BMS, 13 with a first-generation and 11 with a second-generation DES) admitted with an event due to stent failure who had neoatherosclerotic lesions on optical coherence tomography were included in the analysis. The lumen and stent borders were detected and the lipid and calcific tissue were identified in the neointima and their burden was estimated. The neointima attenuation and backscatter indices were computed and compared between the different stent types. Although there were no differences in the neointima burden, the BMS group exhibited thinner fibrous caps (p<0.001), and a numerically increased incidence of lipid-rich plaques (p=0.052) and macrophage accumulation (p=0.012). Neointima discontinuities (p=0.009) and thrombus (p=0.032) were seen more often in first-generation DES. In all stent types, neoatherosclerosis had focal manifestations. In neoatherosclerotic lesions the attenuation and backscatter indices were increased in BMS (p=0.031 and p=0.018, respectively) compared to DES; however, there were no differences between stents in the attenuation indices in subsegments located distally to neoatherosclerotic lesions which had low values in all stent types.

Conclusions: Although there are differences in lipid burden and neointima characteristics in different stent types, in all stents neoatherosclerosis has focal manifestations indicating that, irrespective of the stent type, focal triggers are involved in the generation of vulnerable neolesions.

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