Neoatherosclerosis

Neoatherosclerosis Neointimal proliferation can occur within a coronary stent. Chronic inflammation within the neointima with infiltration of macrophages leads to neoatherosclerosis and result in in-stent restenosis. Disruption of neoatheroma can cause acute thrombotic occlusion [1]. Hence neoatherosclerosis is a complication of percutaneous coronary intervention and can present with recurrence of angina or acute coronary syndrome. Occurrence of neoatherosclerosis is earlier in drug eluting stents than in bare metal stents and has a greater prevalence. Late stent thrombosis due to rupture of the plaques with thin fibrous cap is associated with high mortality [2]. Thus in-stent neoatherosclerosis is an important contributing factor to late vascular complications of very late stent thrombosis and late in-stent restenosis. Neoatherosclerosis is characterized by plenty of lipid laden foamy macrophages, with or without calcification and a necrotic core in the neointima. While native coronary atherosclerosis takes decades to develop, neoatherosclerosis may develop in months to years after stent placement [3]. Lesions of neoatherosclerosis can be detected by optical coherence tomography. A study of 406 neoatherosclerotic lesions from 299 autopsies in the CVPath stent registry included 197 bare metal stents and 209 drug eluting stents. 103 were sirolimus eluting stents and 106 paclitaxel eluting stents. Neoatherosclerosis was noted in 31% of drug eluting stent lesions and 16% of bar...
Source: Cardiophile MD - Category: Cardiology Authors: Tags: Cardiology Source Type: blogs