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Original Articles

Extended Follow-Up by Serial Angioscopic Observation for Bare-Metal Stents in Native Coronary Arteries

From Healing Response to Atherosclerotic Transformation of Neointima

Shinya Yokoyama, MD^*; Masamichi Takano, MD^*; Masanori Yamamoto, MD; Shigenobu Inami, MD; Shunta Sakai, MD; Kentaro Okamatsu, MD; Shinichi Okuni, MD; Koji Seimiya, MD; Daisuke Murakami, MD; Takayoshi Ohba, MD; Ryota Uemura, MD; Yoshihiko Seino, MD; Noritake Hata, MD and Kyoichi Mizuno, MD

From the Intensive Care Unit (S.Y., N.H.), Chiba-Hokusoh Hospital, Nippon Medical School, Chiba, Japan; Division of Cardiology (M.T., S.I., K.M.), Nippon Medical School, Tokyo, Japan; and Cardiovascular Center (M.Y., S.S., K.O., S.O., K.S., D.M., T.O., R.U., Y.S.), Chiba-Hokusoh Hospital, Nippon Medical School, Chiba, Japan.

Correspondence to Masamichi Takano, MD, Division of Cardiology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo 113-8602, Japan. E-mail takanom{at}nms.ac.jp

Received January 29, 2009; accepted April 15, 2009.

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 with 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% versus 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: neointima • plaque • stent • thrombus

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CLINICAL PERSPECTIVE

*Drs Shinya Yokoyama and Masamichi Takano contributed equally to this work.

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