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Published on: September 14, 2009
Morphologic changes in infarct-related plaque after coronary stent placement: a serial angioscopy study
Shunta Sakai1, Kyoichi Mizuno, Shinya Yokoyama
1Department of Cardiovascular Center, Chiba-Hokusoh Hospital, Nippon Medical School, Chiba, Japan.
Insights
Stenting in myocardial infarction (MI) effectively compressed disrupted plaques and reduced thrombus. Six months post-stenting, neointimal coverage led to smooth, white vessel surfaces, indicating plaque stabilization.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Biomedical Imaging
Background:
- Limited data exists on serial morphologic changes post-stenting for acute myocardial infarction (MI).
- The time course of neointimal stent coverage for disrupted plaques remains poorly understood.
Purpose of the Study:
- To investigate morphologic changes in infarct-related lesions after stenting in acute or recent MI.
- To assess the serial changes and neointimal coverage using coronary angioscopy.
Main Methods:
- Coronary angioscopy was performed on 43 patients with MI within seven days of onset.
- Serial examinations included baseline, post-balloon angioplasty, post-stenting, and at one and six months after stenting.
Main Results:
- Baseline lesions showed complex morphology, yellow plaque, and thrombus. Post-stenting eliminated thrombus and intimal flaps, increasing lumen size.
- One-month follow-up revealed irregular surfaces and partial neointimal stent coverage.
- Six-month follow-up demonstrated sufficient neointimal formation, resulting in smooth, white vessel surfaces.
Conclusions:
- Stenting compresses and covers disrupted plaques, widening the vessel lumen.
- Neointimal proliferation following stenting seals unstable plaques, improving lesion morphology.
Objectives:
The aim of this study was to investigate the morphologic changes in infarct-related lesions after stenting in acute or recent myocardial infarction (MI) with coronary angioscopy.
Background:
There is no information on the serial morphologic changes, which occur after stenting, and the time course of neointimal coverage of stents for disrupted unstable plaques.
Methods:
Forty-three patients with MI within seven days of onset were examined. Angioscopy was serially performed for the infarct-related lesions at baseline (n = 43), after balloon angioplasty (n = 35), and after stenting following balloon angioplasty (n = 39) and at one (n = 36) and six months (n = 30) after stenting.
Results:
At baseline, most of the lesions had complex morphology, yellow plaque color, and protruding thrombus (96%, 96%, and 74%, respectively). Although balloon angioplasty reduced the protruding thrombus, it remained in 37%, and an intimal flap was observed in 89% of the lesions. After stenting, the protruding thrombus and intimal flap disappeared, with an increased luminal size obtained in all lesions. At one-month follow-up, an irregular and yellow surface, along with a lining thrombus, was still observed, with partial neointimal stent coverage in most of the lesions. At six-month follow-up, the neointima was found to have sufficiently formed over the stent. The plaque shape and color were almost all classified as smooth (97%) and white (93%).
Conclusions:
These results suggest that a stent not only compressed and covered a disrupted plaque with a protruding thrombus and intimal flap, leading to a wide vessel lumen, but also helped to seal the unstable plaque through neointimal proliferation.
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