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

IF 2.1 Q2 MEDICINE, GENERAL & INTERNAL

Health Science Reports Pub Date : 2025-07-18 DOI:10.1002/hsr2.71072

Xiao-Xia Zhang, Qing Chen, Xiao-Jiang Zhang, Yao-Dong Ding, Guo-Zhong Wang, Mao-Xiao Nie, Yong Zeng

{"title":"Effect of Neoatherosclerosis and Intervention-Associated Neoatheroma Rupture on Clinical Outcomes in Patients With In-Stent Restenosis: A Retrospective Study","authors":"Xiao-Xia Zhang, Qing Chen, Xiao-Jiang Zhang, Yao-Dong Ding, Guo-Zhong Wang, Mao-Xiao Nie, Yong Zeng","doi":"10.1002/hsr2.71072","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Background and Aims</h3>\n \n <p>Treatment 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.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>We 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.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>SNIR occurred in 29 patients after balloon angioplasty. Repeat stenting was more frequent in these patients (48.3% vs. 7.4%, <i>p</i> = 0.009). The incidence of target lesion revascularization (TLR) was significantly higher in patients with SNIR (37.9% vs. 11.1%, <i>p</i> = 0.021), SNIR was an independent risk factors of TLR (HR: 3.997, <i>p</i> = 0.034). In patients with SNIR, repeat stenting significantly reduced the rate of TLR than DCB (14.3% vs. 60.0% <i>p</i> = 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 µm, <i>p</i> = 0.001; 155.5 ± 41.6 vs. 107.7 ± 44.4 degrees, <i>p</i> = 0.000; and 28.2% ± 14.3% vs. 16.0% ± 9.5%, <i>p</i> = 0.001, respectively). Multivariate logistic regression demonstrated that HbA1C (OR = 1.868, <i>p</i> = 0.044) and time from PCI to ISR (OR = 1.278, <i>p</i> = 0.026) were independent predictors of SNIR.</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>Intervention-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.</p>\n </section>\n </div>","PeriodicalId":36518,"journal":{"name":"Health Science Reports","volume":"8 7","pages":""},"PeriodicalIF":2.1000,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/hsr2.71072","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Health Science Reports","FirstCategoryId":"1085","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1002/hsr2.71072","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}

引用次数: 0

Abstract

Background and Aims

Treatment 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.

Methods

We 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.

Results

SNIR 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 µm, 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.

Conclusions

Intervention-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.

Abstract Image

查看原文本刊更多论文

新动脉粥样硬化和介入相关的新动脉粥样硬化破裂对支架内再狭窄患者临床结局的影响：一项回顾性研究

背景与目的药物洗脱支架（DES）支架内再狭窄（ISR）的治疗具有挑战性。新动脉粥样硬化（NA）在DES-ISR中发生得更早、更频繁。本研究旨在分析DES-ISR患者的新动脉粥样硬化形态学和干预相关的新动脉粥样硬化内膜破裂对干预策略和临床结局的影响。方法回顾性分析56例连续接受重复支架植入或药物包被球囊（DCB）治疗的有症状的DES-ISR和光学相干断层扫描（OCT）证实支架内NA的患者。根据球囊血管成形术后是否有严重的新动脉粥样瘤内膜破裂（SNIR）分为两组。分析新生内膜的特征。比较两组患者的干预策略和临床结果。结果球囊血管成形术后发生SNIR 29例。重复支架术在这些患者中更为常见（48.3% vs. 7.4%, p = 0.009）。SNIR患者靶病变血运重建术（TLR）发生率显著高于前者（37.9% vs. 11.1%, p = 0.021）， SNIR是TLR的独立危险因素（HR: 3.997, p = 0.034）。在SNIR患者中，重复支架置入比DCB显著降低TLR发生率（14.3% vs. 60.0% p = 0.014）。SNIR患者新动脉粥样硬化的脂质池深度和最大脂质弧显著较大，框架中新动脉粥样硬化的百分比显著较高(510.1±162.7 vs 370.7±129.6µm, p = 0.001；155.5±41.6和107.7±44.4度,p = 0.000;和28.2%±14.3%比16.0%±9.5%,p = 0.001)。多因素logistic回归分析显示，HbA1C （OR = 1.868, p = 0.044）和PCI至ISR时间（OR = 1.278, p = 0.026）是SNIR的独立预测因子。结论干预相关的严重新动脉粥样硬化破裂增加了TLR复发的风险，重复支架置入比DCB更有效。具有显著脂质池的新动脉粥样硬化与干预相关的SNIR密切相关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊