Abstract
Bare-metal stent (BMS) has been widely used for the treatment of coronary artery disease. Tissue growth in response to implanted BMS forms relatively thick neointima and eventually seals and stabilizes vulnerable plaques containing thrombus. Recent pathological reports suggest that early neointimal growth peaked at 6 months and then the neointimas become thinner at 2–3 years and some of those eventually transform into atherosclerotic tissue (neoatherosclerosis) which mimics atherosclerosis in native coronary arteries. Full-color and 3-dimensional angioscopic images of the coronary lumen provide detailed information on the vessel walls, including the stent segment and atherosclerotic process beyond angiography. Angioscopy enables macroscopic pathological assessment of intra-stent tissue including early thick white neointima with embedded stent struts, thinner late phase neointima with transparent struts, and yellow neoatherosclerosis with newly formed intra-stent thrombus. Angioscopic assessment of serial changes after BMS implantation may have potential benefits on patient’s management after coronary stenting.
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Fuster V, Falk E, Fallon JT, Badimon L, Chesebro JH, Badimon JJ. The three processes leading to post PTCA restenosis: dependence on the lesion substrate. Thromb Haemost. 1995;74:552–9.
Schwartz RS. Drug-eluting stents in preclinical studies: recommended evaluation from a Consensus Group. Circulation. 2002;106:1867–73.
Shinke T, Li J, Chen JP, et al. High incidence of intramural thrombus after overlapping paclitaxel-eluting stent implantation: angioscopic and histopathologic analysis in porcine coronary arteries. Circ Cardiovasc Interv. 2008;1:28–35.
Kotani J, Awata M, Nanto S, et al. Incomplete neointimal coverage of sirolimus-eluting stents: angioscopic findings. J Am Coll Cardiol. 2006;47:2108–11.
Grewe PH, Deneke T, Machraoui A, Barmeyer J, Muller KM. Acute and chronic tissue response to coronary stent implantation: pathologic findings in human specimen. J Am Coll Cardiol. 2000;35:157–63.
Komatsu R, Ueda M, Naruko T, Kojima A, Becker AE. Neointimal tissue response at sites of coronary stenting in humans: macroscopic, histological, and immunohistochemical analyses. Circulation. 1998;98:224–33.
Ueda Y, Nanto S, Komamura K, Kodama K. Neointimal coverage of stents in human coronary arteries observed by angioscopy. J Am Coll Cardiol. 1994;23:341–6.
Takano M, Ohba T, Inami S, Seimiya K, Sakai S, Mizuno K. Angioscopic differences in neointimal coverage and in persistence of thrombus between sirolimus-eluting stents and bare metal stents after a 6-month implantation. Eur Heart J. 2006;27:2189–95.
Sakai S, Mizumo K, Yokoyama S, et al. Morphologic changes in infarct-related plaque after coronary stent placement. A serial angioscopy study. J Am Coll Cardiol. 2003;42:1558–65.
Yokoyama S, Takano M, Sakai S, et al. Difference in neointimal proliferation between ruptured and non-ruptured segments after bare metal stent implantation. Int Heart J. 2010;51:7–12.
Hamm CW, Bassand JP, Agewall S, et al. ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: the task force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2011;32:2999–3054.
Murakami D, Takano M, Yamamoto M, et al. Novel neointimal formation over sirolimus-eluting stents identified by coronary angioscopy and optical coherence tomography. J Cardiol. 2009;53:311–13.
Inoue T, Shinke T, Otake H, et al. Neoatherosclerosis and mural thrombus detection after sirolimus-eluting stent implantation. Circ J Off J Jpn Circ Soc. 2013;78:92–100.
Asakura M, Ueda Y, Nanto S, et al. Remodeling of in-stent neointima, which became thinner and transparent over 3 years: serial angiographic and angioscopic follow-up. Circulation. 1998;97:2003–6.
Kimura T. Long-term clinical and angiographic follow-up after coronary stent placement in native coronary arteries. Circulation. 2002;105:2986–91.
Robinson KA, Roubin G, King S, Siegel R, Rodgers G, Apkarian RP. Correlated microscopic observations of arterial responses to intravascular stenting. Scanning Microsc. 1989;3:665–78; discussion 678–9.
Yokoyama S, Takano M, Yamamoto M, et al. Extended follow-up by serial angioscopic observation for bare-metal stents in native coronary arteries: from healing response to atherosclerotic transformation of neointima. Circ Cardiovasc Interv. 2009;2:205–12.
Nakazawa G, Otsuka F, Nakano M, et al. The pathology of neoatherosclerosis in human coronary implants bare-metal and drug-eluting stents. J Am Coll Cardiol. 2011;57:1314–22.
Chen MS, John JM, Chew DP, Lee DS, Ellis SG, Bhatt DL. Bare metal stent restenosis is not a benign clinical entity. Am Heart J. 2006;151:1260–4.
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© 2015 Springer Japan
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Shinke, T. (2015). Bare-Metal Stent. In: Mizuno, K., Takano, M. (eds) Coronary Angioscopy. Springer, Tokyo. https://doi.org/10.1007/978-4-431-55546-9_14
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DOI: https://doi.org/10.1007/978-4-431-55546-9_14
Publisher Name: Springer, Tokyo
Print ISBN: 978-4-431-55545-2
Online ISBN: 978-4-431-55546-9
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