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Jiang M, Zhang Y, Han Y, Yuan X, Gao L. Neoatherosclerosis: A Distinctive Pathological Mechanism of Stent Failure. Rev Cardiovasc Med 2024; 25:95. [PMID: 39076931 PMCID: PMC11263888 DOI: 10.31083/j.rcm2503095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 11/23/2023] [Accepted: 11/27/2023] [Indexed: 07/31/2024] Open
Abstract
With the development of drug-eluting stents, intimal re-endothelialisation is significantly inhibited by antiproliferative drugs, and stent restenosis transforms from smooth muscle cell proliferation to neoatherosclerosis (NA). As a result of the development of intravascular imaging technology, the incidence and characteristics of NA can be explored in vivo, with some progress made in illustrating the mechanisms of NA. Experimental studies have shed light on the molecular characteristics of NA. More critically, sufficient evidence proves NA as a significant cause of late stent failure. Treatments for NA are still being explored. In this review, we summarise the histopathological characteristics of different types of stent NA, explore the potential relationship of NA with native atherosclerosis and discuss the clinical significance of NA in late stent failure and the promising present and future prevention and treatment strategies.
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Affiliation(s)
- Mengting Jiang
- Senior Department of Cardiology, Sixth Medical Center of Chinese PLA General Hospital, 100048 Beijing, China
| | - Yu Zhang
- Department of Clinical Training and Teaching, Tianjin University of Traditional Chinese Medicine, 301617 Tianjin, China
| | - Yan Han
- Senior Department of Cardiology, Sixth Medical Center of Chinese PLA General Hospital, 100048 Beijing, China
| | - Xiaohang Yuan
- Senior Department of Cardiology, Sixth Medical Center of Chinese PLA General Hospital, 100048 Beijing, China
| | - Lei Gao
- Senior Department of Cardiology, Sixth Medical Center of Chinese PLA General Hospital, 100048 Beijing, China
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Hill AP, Garcia-Garcia HM. Coronary Healing Patterns Following Stenting in Patients With Diabetes as Assessed by Optical Coherence Tomography. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 26:24-25. [PMID: 33632640 DOI: 10.1016/j.carrev.2021.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 02/05/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Andrew P Hill
- Internal Medicine, MedStar Georgetown University Hospital, Washington, DC, USA
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Otsuka K, Villiger M, Nadkarni SK, Bouma BE. Intravascular Polarimetry: Clinical Translation and Future Applications of Catheter-Based Polarization Sensitive Optical Frequency Domain Imaging. Front Cardiovasc Med 2020; 7:146. [PMID: 33005632 PMCID: PMC7485575 DOI: 10.3389/fcvm.2020.00146] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 07/10/2020] [Indexed: 11/13/2022] Open
Abstract
Optical coherence tomography (OCT) and optical frequency domain imaging (OFDI) visualize the coronary artery wall and plaque morphology in great detail. The advent of these high-resolution intracoronary imaging modalities has propelled our understanding of coronary atherosclerosis and provided enhanced guidance for percutaneous coronary intervention. Yet, the lack of contrast between distinct tissue types and plaque compositions impedes further elucidation of the complex mechanisms that contribute to acute coronary syndrome (ACS) and hinders the prospective identification of plaques susceptible to rupture. Intravascular polarimetry with polarization-sensitive OFDI measures polarization properties of the coronary arterial wall using conventional intravascular imaging catheters. The quantitative polarization metrics display notable image contrast between several relevant coronary plaque microstructures that are difficult to identify with conventional OCT and OFDI. Tissues rich in collagen and smooth muscle cells exhibit birefringence, while lipid and macrophages cause depolarization. In this review, we describe the basic principles of intravascular polarimetry, discuss the interpretation of the polarization signatures, and outline promising avenues for future research and clinical implications.
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Affiliation(s)
- Kenichiro Otsuka
- Wellman Center for Photomedicine, Harvard Medical School, Massachusetts General Hospital, Boston, MA, United States
| | - Martin Villiger
- Wellman Center for Photomedicine, Harvard Medical School, Massachusetts General Hospital, Boston, MA, United States
| | - Seemantini K Nadkarni
- Wellman Center for Photomedicine, Harvard Medical School, Massachusetts General Hospital, Boston, MA, United States
| | - Brett E Bouma
- Wellman Center for Photomedicine, Harvard Medical School, Massachusetts General Hospital, Boston, MA, United States.,Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, United States.,Department of Cardiology, Erasmus University Medical Center, Rotterdam, Netherlands
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Otsuka K, Villiger M, Nadkarni SK, Bouma BE. Intravascular Polarimetry for Tissue Characterization of Coronary Atherosclerosis. Circ Rep 2019; 1:550-557. [PMID: 32432174 PMCID: PMC7236778 DOI: 10.1253/circrep.cr-19-0102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 10/03/2019] [Indexed: 01/20/2023] Open
Abstract
The microscopic tissue structure and organization influence the polarization of light. Intravascular polarimetry leverages this compelling intrinsic contrast mechanism by using polarization-sensitive optical frequency domain imaging to measure the polarization properties of the coronary arterial wall. Tissues rich in collagen and smooth muscle cells appear birefringent, while the presence of lipid causes depolarization, offering quantitative metrics related to the presence of important components of coronary atherosclerosis. Here, we review the basic principle, the interpretation of polarization signatures, and first clinical investigations of intravascular polarimetry and discuss how this extension of contemporary intravascular imaging may advance our knowledge and improve clinical practice in the future.
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Affiliation(s)
- Kenichiro Otsuka
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, United States
| | - Martin Villiger
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, United States
| | - Seemantini K Nadkarni
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, United States
| | - Brett E Bouma
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, United States
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, United States
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van den Heuvel M, Sorop O, van Ditzhuijzen NS, de Vries R, van Duin RWB, Peters I, van Loon JE, de Maat MP, van Beusekom HM, van der Giessen WJ, Jan Danser AH, Duncker DJ. The effect of bioresorbable vascular scaffold implantation on distal coronary endothelial function in dyslipidemic swine with and without diabetes. Int J Cardiol 2017; 252:44-51. [PMID: 29191384 DOI: 10.1016/j.ijcard.2017.11.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 10/03/2017] [Accepted: 11/13/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND We studied the effect of bioresorbable vascular scaffold (BVS) implantation on distal coronary endothelial function, in swine on a high fat diet without (HFD) or with diabetes (DM+HFD). METHODS Five DM+HFD and five HFD swine underwent BVS implantation on top of coronary plaques, and were studied six months later. Conduit artery segments >5mm proximal and distal to the scaffold and corresponding segments of non-scaffolded coronary arteries, and segments of small arteries within the flow-territory of scaffolded and non-scaffolded arteries were harvested for in vitro vasoreactivity studies. RESULTS Conduit segments proximal and distal of the BVS edges showed reduced endothelium-dependent vasodilation as compared to control vessels (p≤0.01), with distal segments being most prominently affected(p≤0.01). Endothelial dysfunction was only observed in DM±HFD swine and was principally due to a loss of NO. Endothelium-independent vasodilation and vasoconstriction were unaffected. Surprisingly, segments from the microcirculation distal to the BVS showed enhanced endothelium-dependent vasodilation (p<0.01), whereas endothelium-independent vasodilation and vasoconstriction were unaltered. This enhanced vasorelaxation was only observed in DM+HFD swine, and did not appear to be either NO- or EDHF-mediated. CONCLUSIONS Six months of BVS implantation in DM+HFD swine causes NO-mediated endothelial dysfunction in nearby coronary segments, which is accompanied by a, possibly compensatory, increase in endothelial function of the distal microcirculation. Endothelial dysfunction extending into coronary conduit segments beyond the implantation-site, is in agreement with recent reports expressing concern for late scaffold thrombosis and of early BVS failure in diabetic patients.
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Affiliation(s)
- Mieke van den Heuvel
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Internal Medicine Sector Pharmacology and Metabolic Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands; Netherlands Heart Institute, Utrecht, The Netherlands
| | - Oana Sorop
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands; Netherlands Heart Institute, Utrecht, The Netherlands
| | - Nienke S van Ditzhuijzen
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - René de Vries
- Department of Internal Medicine Sector Pharmacology and Metabolic Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Richard W B van Duin
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Ilona Peters
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Janine E van Loon
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Hematology, Cardiovascular Research School COEUR, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Moniek P de Maat
- Department of Hematology, Cardiovascular Research School COEUR, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Heleen M van Beusekom
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Wim J van der Giessen
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands; Netherlands Heart Institute, Utrecht, The Netherlands
| | - A H Jan Danser
- Department of Internal Medicine Sector Pharmacology and Metabolic Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Dirk J Duncker
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands; Netherlands Heart Institute, Utrecht, The Netherlands.
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