From the Cardiovascular Division, Osaka Police Hospital (M.A., A.H.,
T.A., K.K.); the Division of Cardiology, The First Department of Medicine,
Osaka University School of Medicine (Y.U., M.K., M.H.); and the Cardiovascular
Division, Kansai Rosai Hospital, Amagasaki (S.N.), Japan.
Correspondence to Masanori Asakura, Cardiovascular Division, Osaka Police Hospital, 10–31 Kitayama-cho, Tennoji-ku, Osaka, 543 Japan.
Background—Recently, it has been
reported that the luminal diameter shows phasic changes after stenting:
the progression of luminal narrowing followed by its regression. To
elucidate the mechanisms involved in the phasic changes in luminal
diameter after stenting, we examined the changes in
neointimal thickness and the appearance of
neointima by a series of angiographic and angioscopic
observations for 3 years after stent implantation.
Methods and Results—In 12 patients who received a Wiktor
coronary stent, serial angiographic and angioscopic
examinations were performed immediately, 2 to 4 weeks, 3 months, 6
months, and 3 years after the stenting without repetition of
angioplasty. Neointimal thickness was determined by
angiography as the difference between stent and luminal diameters. The
angioscopic appearance of neointima over the stent was
classified as transparent or nontransparent according to the visibility
of the majority of the stent. Neointimal thickness
increased significantly at 3 months (0.75±0.32 mm) without
further changes at 6 months (0.74±0.32 mm). Thereafter, however,
it decreased significantly over 3 years (0.51±0.26 mm). The
angioscopic appearance was classified as transparent in 8 patients
(100%) immediately after stenting, 6 patients (100%) at 2 to 4 weeks,
2 patients (17%) at 3 months, 2 patients (20%) at 6 months, and 7
patients (58%) at 3 years.
Conclusions—The neointima became thick and
nontransparent until 6 months and then became thin and transparent by 3
years. We conclude that neointimal remodeling exists after
stenting and plays a major role in the alteration of coronary
luminal diameter after stenting.
© 1998 American Heart Association, Inc.
Brief Rapid Communications
Remodeling of In-Stent Neointima, Which Became Thinner and Transparent Over 3 Years
Serial Angiographic and Angioscopic Follow-up
Key Words: stents • angiography • remodeling • restenosis • imaging
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