Effect of Neoatherosclerosis and Intervention-Associated Neoatheroma Rupture on Clinical Outcomes in Patients With In-Stent Restenosis: A Retrospective Study

Background and AimsTreatment of drug-eluting stents (DES) in-stent restenosis (ISR) was challenging. Neoatherosclerosis (NA) occurs earlier and more frequently in DES-ISR. This study aims to analyze the effect of neoatheroma morphology and intervention-associated neoatheroma intima rupture on intervention strategies and clinical outcomes in patients with DES-ISR.MethodsWe retrospectively analyzed 56 consecutive patients with symptomatic DES-ISR and optical coherence tomography (OCT) verified in-stent NA who had been treated by repeat stenting or drug-coated balloon (DCB). Patients were divided into two groups according to whether there was severe neoatheroma intima rupture (SNIR) after balloon angioplasty. Characteristics of the neointima were analyzed. Intervention strategies and clinical outcomes were compared between the two groups.ResultsSNIR occurred in 29 patients after balloon angioplasty. Repeat stenting was more frequent in these patients (48.3% vs. 7.4%, p = 0.009). The incidence of target lesion revascularization (TLR) was significantly higher in patients with SNIR (37.9% vs. 11.1%, p = 0.021), SNIR was an independent risk factors of TLR (HR: 3.997, p = 0.034). In patients with SNIR, repeat stenting significantly reduced the rate of TLR than DCB (14.3% vs. 60.0% p = 0.014). The lipid pool depth and the maximum lipid arc of the neoatheroma were significantly larger and the percentage of the frame with neoatherosclerosis was significantly higher in patients with SNIR (510.1 +/- 162.7 vs. 370.7 +/- 129.6 mu m, p = 0.001; 155.5 +/- 41.6 vs. 107.7 +/- 44.4 degrees, p = 0.000; and 28.2% +/- 14.3% vs. 16.0% +/- 9.5%, p = 0.001, respectively). Multivariate logistic regression demonstrated that HbA1C (OR = 1.868, p = 0.044) and time from PCI to ISR (OR = 1.278, p = 0.026) were independent predictors of SNIR.ConclusionsIntervention-associated severe neoatheroma rupture increased the risk of recurrent TLR, repeat stenting was more effective than DCB in such patients. Neoatherosclerosis with a significant lipid pool is closely related to intervention-associated SNIR.