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Study on the relationship between in-stent neoatherosclerosis and chronic kidney disease: an optical coherence

Yixuan Gao1, Ning Gu1, Yanna Zhou2

  • 1Department of Cardiology, Affiliated Hospital of Zunyi Medical University, No. 149 of Road Dalian, District Huichuan, Zunyi, 563000, China.

Scientific Reports
|July 2, 2025
PubMed

Insights

Patients with kidney failure show higher rates of in-stent neoatherosclerosis (ISNA) and thin-cap fibroatheroma (TCFA) after drug-eluting stent (DES) implantation. Lower estimated glomerular filtration rate (eGFR) correlates with increased ISNA and less stable neointima.

Area of Science:

  • Cardiovascular Medicine
  • Nephrology
  • Biomedical Engineering

Background:

  • In-stent restenosis (ISR) following drug-eluting stent (DES) implantation is a significant clinical challenge.
  • The role of chronic kidney disease (CKD) in the progression of ISR and associated neoatherosclerosis remains incompletely understood.
  • In-stent neoatherosclerosis (ISNA) represents a pathological progression of ISR, characterized by lipid-rich plaque formation.

Purpose of the Study:

  • To investigate the association between varying degrees of chronic kidney disease (CKD) and the prevalence of in-stent neoatherosclerosis (ISNA) in patients with in-stent restenosis (ISR) after DES implantation.
  • To evaluate the relationship between estimated glomerular filtration rate (eGFR) and the characteristics of neointima within ISR lesions, including the presence of thin-cap fibroatheroma (TCFA).

Main Methods:

  • A cohort of 220 patients with confirmed ISR after DES implantation were retrospectively analyzed.
  • Patients were stratified into three groups based on eGFR: normal (≥90 mL/min/1.73 m²), mild impairment (60–89 mL/min/1.73 m²), and kidney failure (<60 mL/min/1.73 m²).
  • Optical coherence tomography (OCT) was utilized to assess ISNA and TCFA within ISR lesions. Clinical and angiographic data were collected and compared across groups.

Main Results:

  • No significant differences in baseline angiographic characteristics were observed among the three eGFR groups.
  • Patients in the kidney failure group exhibited significantly higher rates of ISNA (68.5%) compared to those with mild (46.5%) or normal (42.5%) renal function (p<0.05).
  • The incidence of TCFA within ISR lesions was also significantly higher in the kidney failure group (40.7%) versus the mild (22.1%) and normal (22.5%) renal function groups (p<0.05). A lower eGFR was associated with increased ISNA and reduced neointima stability.

Conclusions:

  • Chronic kidney disease, particularly kidney failure, is independently associated with a higher prevalence of in-stent neoatherosclerosis (ISNA) and thin-cap fibroatheroma (TCFA) in patients with in-stent restenosis (ISR) after DES implantation.
  • Reduced estimated glomerular filtration rate (eGFR) may indicate increased neointimal instability and a higher risk of adverse events in the context of ISR.
  • These findings highlight the importance of considering renal function when assessing cardiovascular risk and managing patients with ISR post-DES implantation.
Keywords:
In-stent restenosisNeoatherosclerosisNeutrophil-to-lymphocyte ratioOptical coherence tomography

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