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The Pathology of Neoatherosclerosis in Human Coronary Implants

Open access
Nakazawa, Gaku, Otsuka, Fumiyuki, Nakano, Masataka, Vorpahl, Marc, Yazdani, Saami K., Ladich, Elena, Kolodgie, Frank D., Finn, Aloke V., Virmani, Renu·2011·Journal of the American College of Cardiology

Abstract

Objectives Human coronary bare metal stents (BMS) and drug-eluting stents (DES) from autopsy cases with implant durations >30 days were examined for the presence of neointimal atherosclerotic disease. Background Neointimal atherosclerotic change (neoatherosclerosis) following BMS implantation is rarely reported and usually occurs beyond 5 years. The incidence of neoatherosclerosis following DES implantation has not been reported. Methods All available cases from the CVPath stent registry (n=299 autopsies), which includes a total of 406 lesions (197 BMS, 209 DES [103 sirolimus-eluting stents (SES), and 106 paclitaxel-eluting stents (PES)]) with implant duration >30 days were examined. Neoatherosclerosis was recognized as clusters of lipid-laden foamy macrophages within the neointima with or without necrotic core formation. Results The incidence of neoatherosclerosis was significantly greater in DES (31%) than BMS (16%) lesions (p<0.001). The median stent duration with neoatherosclerosis was shorter in DES than BMS (DES; 420 [361–683], BMS; 2160 [1800–2880] days, p<0.001). Unstable lesions characterized as thin-cap fibroatheromas or plaque rupture were more frequent in BMS (n=7, 4%) than DES (n=3, 1%) (p=0.17), with relatively shorter implant durations for DES (1.5±0.4 years) compared to BMS (6.1±1.5 years). Independent determinants of neoatherosclerosis identified by multiple logistic regression included younger age (p<0.001), longer implant durations (p<0.001), SES usage (p<0.001), PES usage (p=0.001), and underlying unstable plaques (p=0.004). Conclusions Neoatherosclerosis is a frequent finding in DES and occurs earlier than in BMS. Unstable features of neoatherosclerosis are identified for both BMS and DES with shorter implant durations for the latter. The development of neoatherosclerosis may be yet another rare contributing factor to late thrombotic events.

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Metadata

Authors
Nakazawa, G., Otsuka, F., Nakano, M., Vorpahl, M., Yazdani, S. K., Ladich, E., Kolodgie, F. D., Finn, A. V., & Virmani, R.
Venue
Journal of the American College of Cardiology
Publisher
Elsevier BV
Published
2011-03
Volume
57
Issue
11
Pages
1314-1322
ISSN
0735-1097 (ISSN-L)
OpenAlex
W146325010
Cited by
934
References
18
FWCI
87.09
Type
journal article
Language
en
Open access
bronze

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CoChat. (2026). Citation check: The Pathology of Neoatherosclerosis in Human Coronary Implants. https://app.cochat.ai/papers/10.1016/j.jacc.2011.01.011
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Nakazawa, G., Otsuka, F., Nakano, M., Vorpahl, M., Yazdani, S. K., Ladich, E., Kolodgie, F. D., Finn, A. V., & Virmani, R. (2011). The Pathology of Neoatherosclerosis in Human Coronary Implants. Journal of the American College of Cardiology. https://doi.org/10.1016/j.jacc.2011.01.011

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