Neointimal vulnerability on optical coherence tomography and slow flow during percutaneous coronary intervention of healed neointima

Abstract Backgrounds Healed plaques in native coronary artery indicate the repair phenomenon of ruptured fibrous caps and erosions [1, 2, 3]. associated with plaque vulnerability [4]. A similar is considered to occur neointima after stent implantation [5]. However, there are few reports literature regarding neointimal procedure outcomes healed tissue neointima. Objective The aims this study investigate clinical characteristics, slow flow during percutaneous intervention (PCI), by optical coherence tomography (OCT). Methods We treated 67 lesions PCI for in-stent restenosis (ISR) conducted OCT examinations. was defined as having one or more layers different densities a clear demarcation from underlying components. ISR found 49% (33/67) lesions. angiographic decrease at least 1 grade TIMI final 0 no evidence thrombus, spasm, dissection. Stents strut thickness ≥100 μm were classified thick [6]. Results Compared without neointima, showed significantly longer age (102±72 months vs. 31±39 months, p<0.001), lower high-density lipoprotein cholesterol (HDL-C) (42±12 mg/dl 53±16 mg/dl, p=0.005), higher triglycerides (178±84 138±67 p=0.039), frequency dual antiplatelet therapy (42% [14/33] 74% [25/34], P=0.017), use angiotensin-converting enzyme inhibitor angiotensin II receptor blocker (ACE-I ARB) (61% [20/33] 91% [31/34], P=0.028), usage second-generation drug-eluting stents (DESs) (36% [12/33] 63% [22/34], P=0.029), thick-strut 15% [5/34], P=0.012), larger area (6.8±2.6 mm2 5.2±1.8 mm2, P=0.005), incidence lipid-laden (70% [23/33] 32% [11/34], P=0.002), thin-cap fibroatheromas (58% [19/33] 21% [7/34], rupture (45% [15/33] 9% [3/34], P=0.001), thrombus 3% [1/34], macrophage accumulation P<0.001), microvessels (73% [24/33] neoatherosclerosis (76% [25/33] 38% [13/34], underexpansion (15% [5/33] 44% [15/34], P=0.010). There relations between procedural myocardial infarction. Conclusions vulnerability, age, type, thickness, expansion, therapy, HDL-C levels, ACE-I ARB. PCI. Funding Acknowledgement Type funding sources: None.