Tissue characterization of in-stent neointima using intravascular ultrasound radiofrequency data analysis

Using virtual histology and intravascular ultrasound (VH-IVUS), tissue characterization of restenotic in-stent neointima after drug-eluting stent (DES) and bare metal stent (BMS) implantation was assessed. VH-IVUS was performed in 117 lesions (70 treated with DESs and 47 treated with BMSs) with angiographic in-stent restenosis and intimal hyperplasia (IH) > 50% of the stent area. The region of interest was placed between the luminal border and the inner border of the struts and tissue composition was reported as percentages of IH area (percent fibrous, percent fibrofatty, percent necrotic core, percent dense calcium) at the 2 sites of maximal percent IH and maximal percent necrotic core. Mean follow-up times between stent implantation and VH-IVUS study were 43.5 ± 33.8 months for BMS-treated lesions and 11.1 ± 7.8 months for DES-treated lesions (p < 0.001). The 2 groups had greater percent necrotic core and percent dense calcium at maximal percent IH and maximal percent necrotic core sites, especially in stents that had been implanted for longer periods. In conclusion, this VH-IVUS analysis showed that BMS- and DES-treated lesions develop in-stent necrotic core and dense calcium, suggesting the development of in-stent neoatherosclerosis.