Neoatherosclerosis and Mural Thrombus Detection After Sirolimus-Eluting Stent Implantation – Comparison of Angioscopy and Optical Coherence Tomography Assessment for Color-Based Tissue Characterization –

Takumi Inoue; Toshiro Shinke; Hiromasa Otake; Masayuki Nakagawa; Hirotoshi Hariki; Tsuyoshi Osue; Masamichi Iwasaki; Yu Taniguchi; Ryo Nishio; Noritoshi Hiranuma; Akihide Konishi; Hiroto Kinutani; Junya Shite; Ken-ichi Hirata

doi:10.1253/circj.CJ-13-0374

Cardiovascular Intervention

Neoatherosclerosis and Mural Thrombus Detection After Sirolimus-Eluting Stent Implantation

– Comparison of Angioscopy and Optical Coherence Tomography Assessment for Color-Based Tissue Characterization –

Takumi Inoue, Toshiro Shinke, Hiromasa Otake, Masayuki Nakagawa, Hirotoshi Hariki, Tsuyoshi Osue, Masamichi Iwasaki, Yu Taniguchi, Ryo Nishio, Noritoshi Hiranuma, Akihide Konishi, Hiroto Kinutani, Junya Shite, Ken-ichi Hirata

Author information

Takumi Inoue
Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
Toshiro Shinke
Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
Hiromasa Otake
Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
Masayuki Nakagawa
Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
Hirotoshi Hariki
Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
Tsuyoshi Osue
Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
Masamichi Iwasaki
Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
Yu Taniguchi
Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
Ryo Nishio
Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
Noritoshi Hiranuma
Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
Akihide Konishi
Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
Hiroto Kinutani
Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
Junya Shite
Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
Ken-ichi Hirata
Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine

Keywords: Angioscopy, Neoatherosclerosis, Optical coherence tomography, Sirolimus-eluting stent, Thrombus

JOURNAL FREE ACCESS

2014 Volume 78 Issue 1 Pages 92-100

DOI https://doi.org/10.1253/circj.CJ-13-0374

Editorial (78-1 pp.61-62)

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Abstract

Background: Although both optical coherence tomography (OCT) and angioscopy are robust tools for detecting intrastent thrombi and neoatherosclerosis in vivo, whether OCT findings are comparable with angioscopy findings remains unclear. Methods and Results: 22 patients presenting with de novo lesions underwent 26 sirolimus-eluting stent (SES) implantations, with follow-up OCT and angioscopy at 10 months post-implantation for segmental assessment of the proximal, mid-, and distal SES segments (66 segments). The mean signal intensity index (signal intensity of the neointima/signal intensity of fibrous intimal hyperplasia) was quantified for angioscopically detected in-stent yellow and white segments. The detection rate for red thrombi was numerically higher with angioscopy than with OCT (17% vs. 9%; P=0.053). Angioscopically detected in-stent yellow segments were categorized into 3 OCT patterns: “high-attenuation tissue covering struts” (OCT-defined neoatherosclerosis), “high-attenuation tissue underneath struts,” and “low-attenuation and low-intensity tissue covering struts”; further, macrophage-like appearance was most frequently observed with OCT-defined neoatherosclerosis (56%, 6.3%, and 0%, respectively, P<0.001). The mean signal intensity index of neoatherosclerosis was significantly lower than that of angioscopically detected in-stent white segments (0.929 vs. 0.997, P=0.004). Conclusions: Current OCT-based definitions for thrombus detection may underestimate the presence of subclinical red thrombi. Qualitative and quantitative OCT assessments of the neointima may enhance the detection of neoatherosclerosis over SES in vivo. (Circ J 2014; 78: 92–100)

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