Prevalence and patterns of in-stent neoatherosclerosis in lower extremity artery disease.

Müller, Arne; Bradaric, Christian; Kafka, Andre; Joner, Michael; Cassese, Salvatore; Xhepa, Erion; Kufner, Sebastian; Kastrati, Adnan; Laugwitz, Karl-Ludwig; Ibrahim, Tareq; Koppara, Tobias

doi:10.4244/EIJ-D-22-00615

2023

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Dokumenttyp:: Journal Article
Autor(en):: Müller, Arne; Bradaric, Christian; Kafka, Andre; Joner, Michael; Cassese, Salvatore; Xhepa, Erion; Kufner, Sebastian; Kastrati, Adnan; Laugwitz, Karl-Ludwig; Ibrahim, Tareq; Koppara, Tobias
Titel:: Prevalence and patterns of in-stent neoatherosclerosis in lower extremity artery disease.
Abstract:: BACKGROUND: In-stent restenosis (ISR) is responsible for a rapid decline of vessel patency after stenting. To date, little is known about the role of in-stent neoatherosclerosis (NA) in stent failure in lower limb arteries. AIMS: This study aimed to determine the prevalence and patterns of in-stent NA in patients with symptomatic ISR of the lower extremity vasculature using intravascular optical coherence tomography (OCT) imaging. METHODS: Patients underwent endovascular revascularisation for ISR including angiography and OCT imaging. NA was defined as the presence of at least 1 fibroatheroma or fibrocalcific plaque within the neointima of a stented segment. RESULTS: Using OCT, we imaged 24 symptomatic patients with lower extremity artery disease (LEAD), with a total of 30 ISR in the lower limbs, prior to their scheduled endovascular interventions. NA formation was observed in 23 (76.7%) lesions, while all stents with an implant duration >5 years (n=8) showed signs of NA. The time from stent implantation to OCT was significantly increased in lesions with NA (p=0.002). Lesions without NA had a significantly shorter duration from index procedure to OCT than those with ≥50 percent (n=9; p=0.003) or <50 percent (n=14; p=0.015) of frames exhibiting signs of NA. NA was predominantly characterised by fibroatheroma with thick fibrous caps with or without calcification. CONCLUSIONS: In-stent NA is frequently identified by OCT imaging after endovascular therapy in lower limb arteries; this increased both in frequency and extent the longer the duration since implantation. Our findings indicate an active atherosclerotic process that may need tailored mitigation strategies.
Zeitschriftentitel:: EuroIntervention
Jahr:: 2023
Band / Volume:: 18
Heft / Issue:: 17
Seitenangaben Beitrag:: 1462-1470
Volltext / DOI:: doi:10.4244/EIJ-D-22-00615
PubMed:: http://view.ncbi.nlm.nih.gov/pubmed/36714952
Print-ISSN:: 1774-024X
TUM Einrichtung:: Klinik und Poliklinik für Innere Medizin I, Kardiologie
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mediaTUM Gesamtbestand Einrichtungen Schools TUM School of Medicine and Health Departments Clinical Medicine Klinik und Poliklinik für Innere Medizin I, Kardiologie (Prof. Laugwitz)2023