Deng Chancui, Liu Zhijiang, Zhang Wei, Deng Yi, Liu Hanlin, Bai Zhixun, Rong Jidong, Deng Wenwen, Gu Ning, Shen Youcheng, Hu Xingwei, Zhao Yongchao, Zhao Ranzun, Shi Bei
Department of Cardiology, Affiliated Hospital of Zunyi Medical University, 563000 Zunyi, Guizhou, China.
Rev Cardiovasc Med. 2023 Nov 30;24(12):341. doi: 10.31083/j.rcm2412341. eCollection 2023 Dec.
Neoatherosclerosis (NA) is associated with stent failure. However, systematic studies on the manifestations of NA and neovascularization (NV) at different stages after drug-eluting stent (DES) implantation are lacking. Moreover, the relationship between NA and NV in in-stent restenosis (ISR) has not been reported. This study aimed to characterize NA and NV in patients with ISR at different post-DES stages and compare the association between NA and NV in ISR lesions.
A total of 227 patients with 227 lesions who underwent follow-up optical coherence tomography before percutaneous coronary intervention for DES ISR were enrolled and divided into early (E-ISR: 1 year), late (L-ISR: 1-5 years), and very-late (VL-ISR: 5 years) ISR groups. Furthermore, ISR lesions were divided into NV and non-NV groups according to the presence of NV.
The prevalence of NA and NV was 52.9% and 41.0%, respectively. The prevalence of lipidic NA (E-ISR, 32.7%; L-ISR, 50.0%; VL-ISR, 58.5%) and intimal NV (E-ISR, 14.5%; L-ISR, 30.8%; VL-ISR, 38.3%) increased with time after stenting. NA was higher in ISR patients with NV lesions than in those without ( 0.001). Patients with both ISR and NV had a higher incidence of macrophage infiltration, thin-cap fibroatheroma, intimal rupture, and thrombosis ( 0.01).
Progression of lipidic NA was associated with L-ISR and VL-ISR but may not be related to calcified NA. NA was more common in ISR lesions with NV; its formation may substantially promote NA progression and plaque instability.
新型动脉粥样硬化（NA）与支架失败相关。然而，目前缺乏关于药物洗脱支架（DES）植入后不同阶段NA和新生血管形成（NV）表现的系统研究。此外，NA与支架内再狭窄（ISR）中NV的关系尚未见报道。本研究旨在描述DES植入后不同阶段ISR患者的NA和NV特征，并比较ISR病变中NA与NV的关联。
共有227例患有227处病变的患者在接受DES ISR经皮冠状动脉介入治疗前接受了随访光学相干断层扫描，并分为早期（E-ISR：<1年）、晚期（L-ISR：1 - 5年）和极晚期（VL-ISR：>5年）ISR组。此外，根据NV的存在情况将ISR病变分为NV组和非NV组。
NA和NV的患病率分别为52.9%和41.0%。脂质型NA（E-ISR，32.7%；L-ISR，50.0%；VL-ISR，58.5%）和内膜NV（E-ISR，14.5%；L-ISR，30.8%；VL-ISR，38.3%）的患病率随支架植入后的时间增加。有NV病变的ISR患者的NA高于无NV病变者（P<0.001）。同时患有ISR和NV的患者巨噬细胞浸润、薄帽纤维粥样斑块、内膜破裂和血栓形成的发生率更高（P<0.01）。
脂质型NA的进展与L-ISR和VL-ISR相关，但可能与钙化型NA无关。NA在伴有NV的ISR病变中更常见；其形成可能会显著促进NA进展和斑块不稳定。
