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Review
. 2022 Mar 8;12(3):393.
doi: 10.3390/life12030393.

In Stent Neo-Atherosclerosis: Pathophysiology, Clinical Implications, Prevention, and Therapeutic Approaches

Annunziata Nusca  1 , Michele Mattia Viscusi  1 , Francesco Piccirillo  1 , Aurelio De Filippis  1 , Antonio Nenna  2 , Cristiano Spadaccio  3 , Francesco Nappi  4 , Camilla Chello  2 , Fabio Mangiacapra  1 , Francesco Grigioni  1 , Massimo Chello  2 , Gian Paolo Ussia  1
Affiliations
Review

In Stent Neo-Atherosclerosis: Pathophysiology, Clinical Implications, Prevention, and Therapeutic Approaches

Annunziata Nusca et al. Life (Basel). .

Abstract

Despite the dramatic improvements of revascularization therapies occurring in the past decades, a relevant percentage of patients treated with percutaneous coronary intervention (PCI) still develops stent failure due to neo-atherosclerosis (NA). This histopathological phenomenon following stent implantation represents the substrate for late in-stent restenosis (ISR) and late stent thrombosis (ST), with a significant impact on patient's long-term clinical outcomes. This appears even more remarkable in the setting of drug-eluting stent implantation, where the substantial delay in vascular healing because of the released anti-proliferative agents might increase the occurrence of this complication. Since the underlying pathophysiological mechanisms of NA diverge from native atherosclerosis and early ISR, intra-coronary imaging techniques are crucial for its early detection, providing a proper in vivo assessment of both neo-intimal plaque composition and peri-strut structures. Furthermore, different strategies for NA prevention and treatment have been proposed, including tailored pharmacological therapies as well as specific invasive tools. Considering the increasing population undergoing PCI with drug-eluting stents (DES), this review aims to provide an updated overview of the most recent evidence regarding NA, discussing pathophysiology, contemporary intravascular imaging techniques, and well-established and experimental invasive and pharmacological treatment strategies.

Keywords: coronary artery disease; in-stent restenosis; neo-atherosclerosis; optical coherence tomography; percutaneous coronary intervention.

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Conflict of interest statement

The authors declare no conflict of interest. the authors report no relationships that could be construed as a conflict of interest.

Figures

Figure 1
Figure 1
(A) Native atherosclerotic plaque. (B) In-stent restenosis. (C) Intra-stent neo-atherosclerosis.
Figure 2
Figure 2
In-stent neoatherosclerosis detected by IVUS (A) and OCT (B).
Figure 3
Figure 3
Overview of potential pharmacological and invasive strategies for neo-atherosclerosis prevention and treatment.
See this image and copyright information in PMC

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