Showa University Fujigaoka Hospital, Yokohama, Japan.
Showa University Fujigaoka Hospital, Fujigaoka 1-30, Aoba, Yokohama, Kanagawa 227-8501, Japan.
Ther Adv Cardiovasc Dis. 2023 Jan-Dec;17:17539447231199660. doi: 10.1177/17539447231199660.
Since their emergence, drug-coated balloons (DCBs) have been used widely to treat in-stent lesions with coronary artery disease (CAD). However, despite their superior efficacy to balloon angioplasty, how DCBs affect neointimal characteristics is poorly understood.
We aimed to assess the neointimal characteristic changes following DCB treatment.
Using optical frequency domain imaging (OFDI), we serially observed the in-stent lesion site just after and 1 year after DCB angioplasty in 12 lesions of 11 patients with repeated revascularization. Neoatherosclerosis was defined as lipid-laden neointima with or without calcification in the stented lesion. Progression or regression of neoatherosclerosis, newly formed neointimal calcification, newly formed uncovered strut and newly formed evagination were assessed. Tiny tissue protrusion was also recorded as mushroom-like protrusion.
Underlying stents were first-generation ( = 5) or newer ( = 7) drug-eluting stents (DESs) with implantation durations ranging from 1 to 15 years (median 8 years). Surprisingly, two-thirds of the lesions (67%, 8 of 12) showed progression of neoatherosclerosis, while a quarter of lesions (25%, 3 of 12) showed regression of neoatherosclerosis. The maximal lipid arc increased from 122° to 174°. Newly formed neointimal calcification was observed in 2 of 12 lesions (16%). Newly formed uncovered struts (33%; 4 of 12) and newly formed evaginations (33%; 4 of 12) were not rare. Mushroom-like protrusion was found in a quarter of lesions (25%; 3 of 12).
Our study demonstrated that a considerable number of lesions showed varied neointimal characteristic changes in a small number of patients. Further studies in a larger population are needed to understand the clinical impact of these findings.
自问世以来，药物涂层球囊（DCB）已广泛用于治疗冠状动脉疾病（CAD）的支架内病变。然而，尽管 DCB 的疗效优于球囊血管成形术，但人们对 DCB 如何影响新生内膜特征知之甚少。
我们旨在评估 DCB 治疗后新生内膜特征的变化。
使用光频域成像（OFDI），我们对 11 名患者的 12 个病变中的 12 个病变进行了重复血运重建，在 DCB 血管成形术后即刻和 1 年后连续观察支架内病变部位。新动脉粥样硬化定义为支架内病变中有或无钙化的富含脂质的新生内膜。评估新动脉粥样硬化的进展或消退、新形成的新生内膜钙化、新形成的未覆盖支架和新形成的外突。还记录了微小组织突起，如蘑菇状突起。
基础支架为第一代（ = 5）或更新一代（ = 7）药物洗脱支架（DES），植入时间从 1 年到 15 年不等（中位数为 8 年）。令人惊讶的是，三分之二的病变（67%，12 个中的 8 个）表现出新生动脉粥样硬化的进展，而四分之一的病变（25%，12 个中的 3 个）表现出新生动脉粥样硬化的消退。最大脂质弧从 122°增加到 174°。12 个病变中有 2 个（16%）观察到新形成的新生内膜钙化。新形成的未覆盖支架（33%，12 个中的 4 个）和新形成的外突（33%，12 个中的 4 个）并不少见。四分之一的病变（25%，12 个中的 3 个）发现蘑菇状突起。
我们的研究表明，在少数患者中，相当数量的病变表现出不同的新生内膜特征变化。需要在更大的人群中进行进一步的研究，以了解这些发现的临床影响。
