1. OCT and Stent Thrombosis
Ik-Kyung Jang, MD, PhD
Professor of Medicine
Harvard Medical School

2. Disclosure Research grant: LLI/St
Disclosure Research grant: LLI/St. Jude medical, Medtronic, Abbott Vascular, JNJ Consultant: LLI/St. Jude medical

3. Stent Thrombosis Acute: BMS, DES Intermediate: DES up to 2 years
Chronic: BMS after 5 years
DES after 2 years

4. Stent Thrombosis
Acute: BMS, DES
Intermediate
Chronic

5. Stent Thrombosis Acute: BMS, DES Malapposition (underexpansion)
Edge dissection
Thrombus

6. Stent Thrombosis
Acute
Intermediate: DES up to 2 years
Chronic

7. Stent Struts Coverage/Apposition
A: well apposed and covered
B: well apposed, not covered
C: malapposed, not covered
D: malapposed, but covered
(A)
(B)
(C)
(D)
Takano.. Jang, Mizuno. AJC 2007

8. OCT for SES Takano Matsumoto Yao Chen F/U 3 mo 6 mo 8.6 mo 12 mo 24 mo
NIH thickness 29 53 42
120/40 88 71
Exposed (%) 15 11
9.2 17
6.6 5
Malapp (%) 16
1.3 2
1.4
Expo+Mala (%) 6 1
Thrombus (%) 14
Takano, Mizuno. AJC 2007, Matsumoto, Shite. EHJ 2007,
Chen. Heart 2008, Xie, Takano, Mizuno. AJC 2008, Takano, Mizuno. JACC 2008, Yao, Suzuki. Chinese Med J 2008.

9. OCT for SES Takano (BMS) Matsumoto Yao Chen F/U 3 mo 6 mo 8.6 mo
NIH thickness 29
351 53 42
120/40
590/200 88 71
Exposed (%) 15
0.1 11
9.2 17
0.3
6.6 5
Malapp (%) 16
1.1
1.3 2
1.4
Expo+Mala (%) 6 1
Thrombus (%) 14

10. SES v PES: 9 mo F/U 14 12 SES 10 PES 8 6 4 2 % exposed strut
12.5 12
SES 10
PES 8
P =0.067
P=0.037
5.4 6 4
2.6
2.6
1.5
1.7 2
% exposed strut
% Malapposition
% exposed +
malapposition
Kim JS. Int J Card 2011 10

11. SES v PES v ZES: 9 mo F/U
Kim JS. JACC CV Interv 2009

12. Stent Thrombosis Acute Intermediate Chronic: BMS after 5 years
DES after 2 years

13. Evolution following BMS
PCI
6mo 3Y 5Y
Angio (MLD, mm)
Histology
OCT
Thrombus
+++ mφ
α-actin - cells
ECM
+++ α-actin +SMCs
+ mφ, +vWF
vWF
+ mφ
microvessels
Neoatheroma?
Signal-rich homogenous neointima ??

14. Late changes of Neointima: BMS
Takano, Mizuno. JACC 2010

15. Late changes of Neointima: BMS

16. OCT for Neointima inside BMS
< 6 mo
(n=20)
> 5 yrs
(n=21)
Lipid laden intima
67%
< 0.05
Intimal disruption
38%
Thrombus 5%
25%
Intraintimal neovascularization
62%
0.01
Takano, Mizuno. JACC 2010

17. JB Hou. , H Qi. , JY Kong. , MM Zhang. , LJ Ma. , HM Liu. , CY LB Meng
JB Hou*, H Qi*, JY Kong*, MM Zhang*, LJ Ma*, HM Liu*, CY LB Meng*, SA Yang*, SS Zhang*, B Yu*, and IK Jang**
Collaboration between:
Harbin Medical University*, and
Massachusetts General Hospital**

18. Lipid-rich plaque inside BMS
- 39 pts with 6.5 yr f/u
- 20/60 (33%) stents, 16/39 (41%) patients
- Fibrous cap thickness: 56.7 ± 5.8 µm
- Lipid arc: 173 ± 57.7°
- Plaque disruption: 6/20 (30%)
- Thrombus: 1/20 (5%)
- Macrophage: 7/20 (35%)
Heart 2010;96:1187

19. Comparison between patients with vs without LRP
Patients with in-stent lipid-rich plaque (n=16)
Patients without in-stent lipid-rich plaque (n=23) P
Follow-up period, (years)
6.6±1.4
6.5±1.2
Age (years)
61.1±7.5
60.1±10.5
0.752
Male, n (%)
14 (87.5%)
16 (69.6%)
0.357
Hypertension, n (%)
13 (81.3%)
9 (39.1%)
0.009
Diabetics, n (%)
4 (25%)
1 (4.3%)
0.139
Smoking, n (%)
9 (56.3%)
5 (21.7%)
0.027
Hyperlipidemia, n (%)
13(81.3%)
15(65.2%)
0.464

20. Characterization of Neointima inside SES using Quantitative Tissue Property Analysis Program
Collaboration between
Harbin Medical University and
Massachusetts General Hospital

21. Aims of the study
- To evaluate the nature of neointima tissue inside SES
- To compare the evolution of tissue property over time
- To identify associated vascular changes

22. Tissue Property Analysis

23. Tissue Property Analysis

24. Results 136 SES in 96 patients:
Group 1: < 24 mo (98 stents in 71 pts)
Group 2: > 24 mo (35 stents in 25 pts)

25. OCT assessment of neointima
Group 1 (98)
Group 2 (35) P
Cross sections (n)
1857
644
Cross sections with NIT>100um (n)
687
277
Covered cross sections (n,%)
1256(67.6%)
472(73.3%)
0.007
Average NIT (mm)
0.13±0.11
0.16±0.14
0.001
Neointima area (mm2)
1.13±0.93
1.25±1.13
0.006
Microchannel (n,%)
48(2.6%)
46(7.1%)
Lipid plaque (n,%)
5(0.8%)

26. Tissue property analysis
Group 1 (n=687)
Group 2 (n=277) P
Attenuation
0.841±1.690
0.791±1.966
0.727
backscatter
6.467±0.757
6.584±0.723
0.019
Correlation Coefficient
-0.355±0.498
-0.367±0.538
0.204
Min intensity
5.191±0.762
5.176±0.719
0.973
Max intensity
7.867±0.701
7.893±0.645
0.528
Mean intensity
6.686±0.668
6.716±0.649
0.518
Variance
0.386±0.094
0.387±0.091
0.766
Heterogeneous neointima (n,%)
82（11.9%）
51（18.4%）
0.008

27. Conclusion (1) Neointima characteristics change over time after SES.
The incidence of heterogenous neointima was higher in the longer f/u group.
The heterogenous group had higher incidence of angiogenesis and lipid-rich plaque.

28. Conclusion (2)
Neointimal heterogeneity may be an important factor for late stability of SES
First study to quantitatively analyze the tissue property of neointima after SES using the new off line tissue property analysis system

29. Percentage of Patients With Atherosclerotic Change in DES Versus BMS in Relation to Duration of Implant at Autopsy
Nakazawa, G. et al. J Am Coll Cardiol Img 2009;2:
Copyright ©2009 American College of Cardiology Foundation. Restrictions may apply.

30. Summary Acute: BMS, DES malapposition, dissection, thrombus
Intermediate: DES up to 2 years
Strut surface coverage
Chronic: BMS after 5 years
DES after 2 years
Neoatherosclerosis

31. Limitation
Lack of correlation between OCT finding and clinical outcome!

32. MGH OCT Registry http://www.massgeneral.org/octregistry
Target 3000 patients x 3 years
20 sites from Australia, China, Singapore, Japan, Korea, USA
Data collection started in 6/2010
As of 2/25/2011, 335 patients enrolled

33. Thank You