Published Online
on April 21, 2009

A more recent version of this article appeared on June 1, 2009

This Article Full Text (PDF) All Versions of this Article: 2/3/205    most recent CIRCINTERVENTIONS.109.854679v1 Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Yokoyama, S. Articles by Mizuno, K. Search for Related Content PubMed Articles by Yokoyama, S. Articles by Mizuno, K. Related Collections Catheter-based coronary interventions: stents

Original Article

Extended Follow-Up by Serial Angioscopic Observation for Bare-Metal Stents in Native Coronary Arteries: From Healing Response to Atherosclerotic Transformation of Neointima

Shinya Yokoyama¹; Masamichi Takano^2,3; Masanori Yamamoto¹; Shigenobu Inami²; Shunta Sakai¹; Kentaro Okamatsu¹; Shinichi Okuni¹; Koji Seimiya¹; Daisuke Murakami¹; Takayoshi Ohba¹; Ryota Uemura¹; Yoshihiko Seino¹; Noritake Hata¹ and Kyoichi Mizuno²

¹ Chiba-Hokusoh Hospital, Nippon Medical School, Chiba, Japan;
² Nippon Medical School, Tokyo, Japan

³ E-mail: takanom{at}nms.ac.jp

Background—Although coronary angiograms after bare-metal stent (BMS) implantation show late luminal narrowing beyond 4 years, the detailed changes inside the BMS have not yet been fully elucidated.

Methods and Results—Serial angiographic and angioscopic examinations were performed immediately (baseline), 6 to 12 months (first follow-up), and 4 years (second follow-up) after stenting without target lesion revascularization in 26 segments of 26 patients who received BMS deployment for their native coronary arteries. Angioscopic observation showed atherosclerotic yellow plaque crushed out by stent struts in 22 patients (85%) and mural thrombus in 21 patients (81%) at baseline. At first follow-up, white neointimal hyperplasia was almost completely buried inside the struts, and both yellow plaque and thrombus had decreased in comparison to the baseline (12% and 4%, respectively; P<0.001). The frequencies of yellow plaque and thrombus increased from the first to second follow-ups (58% and 31%, respectively; P<0.05). All of the yellow plaques in the second follow-up were located not exterior to the struts but protruding from the vessel wall into the lumen. Late luminal narrowing, defined as an increasing of percent diameter stenosis between the first and second follow-ups, was greater in segments with yellow plaque than in those without yellow plaque (18.4±17.3% vs. 3.6±4.2%, respectively; P=0.011).

Conclusions—This angiographic and angioscopic study suggests that white neointima of the BMS may often change into yellow plaque over an extended period of time, and atherosclerotic progression inside the BMS may contribute to late luminal narrowing.

Key Words: plaque • stents • thrombus

Author contributions: Drs Shinya Yokoyama and Masamichi Takano contributed equally to this work.

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