Author + information
- S1936879815021743-ea12c212f34ca6477b10bdc0c4cb8485Andrew D. LaCombe1,
- S1936879815021743-171e830cd1dcc9034ad14cdf44624cceAndrew O'Brien1,
- S1936879815021743-c95177966dcb45c813f7adede42163d5Ryan Farley1,
- S1936879815021743-2756ce77819f38a4fe6798400f71ac26Edwin Mandieka1,
- S1936879815021743-6655356ce94205b23b282148a25e21abJacob Bundy1,
- S1936879815021743-b7b66f6edd8623e8380cc90434ff63c5Austin Clarey1,
- S1936879815021743-1a7495aaabdb2338e3ed61fbcd8a120eMohsin Khan2,
- S1936879815021743-60476037fcaf6848be38330ee4db5f7eAbbey Mulder2,
- S1936879815021743-fa502a35a9a772b6cfc23f1afbcf9bbcMatthew Elmore2,
- S1936879815021743-ec5886024309212374af79cbe5af40f2Jessica Campbell2,
- S1936879815021743-ee1a2e7fa3c6c5f0921cd4618cde4d3cStacie VanOosterhout2,
- S1936879815021743-e53bd014e07a01d4bbdcf60e755fdad4Andrew Borgman2 and
- S1936879815021743-8632eee5d42c6feb3def5ea91f5a5a17Ryan D. Madder2
In pre-existing coronary stents, the detection of lipid-rich plaque (LRP) by near-infrared spectroscopy (NIRS) at the site of neointimal tissue detected by intravascular ultrasound (IVUS) might represent neoatherosclerosis. The relationship between combined NIRS-IVUS measurements and stent failure remains unknown. Therefore, the purpose of the present study is to determine the correlation between combined NIRS-IVUS measurements and subsequent stent failure.
Using data from a single center registry, pre-existing stents implanted >4 months prior to NIRS-IVUS imaging were studied. At sites within stents found to have neointimal tissue by IVUS, NIRS chemograms were interrogated for superimposed LRP, defined as ≥1 bright yellow block on the NIRS block chemogram. The maximum lipid core burden index in 4-mm (maxLCBI4mm) was measured within all stents. Stent failure during follow-up after NIRS-IVUS imaging was defined as either in-stent restenosis requiring revascularization or stent thrombosis.
NIRS-IVUS imaging was performed in 60 pre-existing stents (16.7% bare-metal; 83.3% drug-eluting) implanted 5.5 ± 4.0 years previously. Neointimal tissue with superimposed LRP was detected by combined NIRS-IVUS imaging in 13 (21.7%) stents. Pre-existing stents having neointimal tissue and superimposed LRP were associated with a significantly greater maxLCBI4mm (462 ± 187 vs 129 ± 131, p<0.001) and a greater frequency of a maxLCBI4mm ≥400 (61.5% vs 4.3%, p<0.001). During a follow-up period of 471 ± 269 days after NIRS-IVUS imaging, stents having neointimal tissue and superimposed LRP at baseline developed subsequent stent failure in 30.8% of cases. By comparison, subsequent stent failure occurred in only 1 (2.1%) of 47 stents that lacked neointimal tissue and superimposed LRP (p=0.034).
Among pre-existing coronary stents, neointimal tissue with superimposed LRP detected by combined NIRS-IVUS imaging was associated with a high rate of subsequent stent failure. While this association between NIRS-IVUS findings and the occurrence of stent failure is provocative, the present findings require confirmation in a larger series of patients.