Development of lipid-rich plaque inside bare metal stent: possible mechanism of late stent thrombosis? An optical coherence tomography study
- Jingbo Hou1,
- Hai Qi1,
- Maomao Zhang1,
- Lijia Ma1,
- Huimin Liu1,
- Zhigang Han1,
- Lingbo Meng1,
- Shuang Yang1,
- Shaosong Zhang2,
- Bo Yu1,
- Ik-Kyung Jang3
- 1Department of Cardiology, Second Affiliated Hospital of Harbin Medical University; Key Laboratories of Education Ministry for Myocardial Ischaemia Mechanism and Treatment, Harbin, Heilongjiang, China
- 2LightLab Imaging Inc., Westford, Massachusetts, USA
- 3Harvard Medical School Cardiology Laboratory for Integrative Physiology and Imaging (CLIPI) Cardiology Division, Massachusetts General Hospital, Boston, USA
- Correspondence to Dr Bo Yu, Department of Cardiology, Key Laboratories of Education Ministry for Myocardial Ischaemia Mechanism and Treatment, Second Affiliated Hospital of Harbin Medical University, Harbin, P.R. China;
Contributors JH, IKJ and BY designed the study, analysed the data, drafted and revised the manuscript. BY give the final approval for the manuscript submitted. The other authors took part in the collection and analysis of the data.
- Accepted 6 April 2010
Aims To study in-stent tissue characteristics by optical coherence tomography (OCT) at long-term follow-up in patients with previous bare metal stent implantation.
Methods and results Among 1636 patients who underwent bare metal stent (BMS) implantation between 1999 and 2006, 39 patients with 60 BMS who developed recurrent ischaemia underwent repeat catheterisation and OCT imaging between June 2008 and August 2009. The average time interval between initial BMS implantation and OCT imaging was 6.5±1.3 years. A lesion that had features of lipid-rich plaque was found in 20 stents (33.3%) in 16 patients (41%). Fibrous intima was observed in the remaining 40 stents. In the group with lipid-rich plaque, average fibrous cap thickness was 56.7±5.8 μm and lipid arc was 173±58. Six patients had evidence of recent plaque disruption and another six patients had mural thrombus. Hypertension and smoking were more common in these patients than in those with fibrous intima.
Conclusions Lipid-rich plaque with a thin fibrous cap was seen in patients with previous BMS implantation and recurrent ischaemia at late follow-up. This may be one possible mechanism for late stent thrombosis.
Competing interests SZ is an employee of LightLab Imaging; IKJ received research grant from LightLab Imaging.
Patient consent Obtained.
Ethics approval This study was conducted with the approval of the IRB of the 2nd affiliated hospital of Harbin Medical University.
Provenance and peer review Not commissioned; externally peer reviewed.