{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T19:53:07Z","timestamp":1792093987880,"version":"4.4.0"},"reference-count":37,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"25","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circulation"],"published-print":{"date-parts":[[2011,6,28]]},"abstract":"<jats:sec>\n            <jats:title>Background\u2014<\/jats:title>\n            <jats:p>We report findings from optical coherence tomography (OCT) of in-stent neoatherosclerosis as a cause of drug-eluting stent (DES) failure.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods and Results\u2014<\/jats:title>\n            <jats:p>\n              Optical coherence tomography and grayscale and virtual histology intravascular ultrasound were performed in 50 patients (30 stable, 20 unstable angina) with 50 DES in-stent restenosis lesions and intimal hyperplasia &gt;50% of stent area. Median follow-up time was 32.2 months. Overall, 26 lesions (52%) had at least 1 OCT-defined in-stent thin-cap fibroatheroma (TCFA)\u2013containing neointima and 29 (58%) had at least 1 in-stent neointimal rupture. Patients presenting with unstable angina showed a thinner fibrous cap (55 \u03bcm [interquartile range 42 to 105 \u03bcm] versus 100 \u03bcm [interquartile range 60 to 205 \u03bcm],\n              <jats:italic>P<\/jats:italic>\n              =0.006) and higher incidence of OCT-defined TCFA-containing neointima (75% versus 37%,\n              <jats:italic>P<\/jats:italic>\n              =0.008), intimal rupture (75% versus 47%,\n              <jats:italic>P<\/jats:italic>\n              =0.044), thrombi (80% versus 43%,\n              <jats:italic>P<\/jats:italic>\n              =0.010), and red thrombi (30% versus 3%,\n              <jats:italic>P<\/jats:italic>\n              =0.012) than stable patients. Fibrous cap thickness negatively correlated with follow-up time (\n              <jats:italic>r<\/jats:italic>\n              =\u22120.318,\n              <jats:italic>P<\/jats:italic>\n              =0.024). Compared with DES &lt;20 months after implantation (the best cut-off to predict TCFA-containing neointima), DES \u226520 months after implantation had a higher incidence of TCFA-containing neointima (69% versus 33%,\n              <jats:italic>P<\/jats:italic>\n              =0.012) and red thrombi (27% versus 0%,\n              <jats:italic>P<\/jats:italic>\n              =0.007). Patients with unstable (versus stable) angina had an increasing number of unstable OCT findings including TCFA-containing neointima, neointima rupture, and thrombus (\n              <jats:italic>P<\/jats:italic>\n              =0.027). The rate of agreement between grayscale intravascular ultrasound and OCT for detecting intimal rupture was 50% and for detecting thrombus was 44%. The agreement between virtual histology intravascular ultrasound and OCT for identifying TCFA-containing neointima was 78%.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions\u2014<\/jats:title>\n            <jats:p>In-stent neoatherosclerosis may be an important mechanism of DES failure, especially late after implantation.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circulationaha.110.988436","type":"journal-article","created":{"date-parts":[[2011,6,7]],"date-time":"2011-06-07T01:54:46Z","timestamp":1307411686000},"page":"2954-2963","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":317,"title":["Optical Coherence Tomographic Analysis of In-Stent Neoatherosclerosis After Drug\u2013Eluting Stent Implantation"],"prefix":"10.1161","volume":"123","author":[{"given":"Soo-Jin","family":"Kang","sequence":"first","affiliation":[{"name":"From the Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea (S.K., D.P., J.L., W.K., S.L., Y.K., C.W.L., S.-W.P., S.-J.P.); Cardiovascular Research Foundation, New York, NY (G.S.M.); and the Division of Cardiovascular Medicine, Wakayama Medical University, Japan (T.A.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gary S.","family":"Mintz","sequence":"additional","affiliation":[{"name":"From the Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea (S.K., D.P., J.L., W.K., S.L., Y.K., C.W.L., S.-W.P., S.-J.P.); Cardiovascular Research Foundation, New York, NY (G.S.M.); and the Division of Cardiovascular Medicine, Wakayama Medical University, Japan (T.A.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takashi","family":"Akasaka","sequence":"additional","affiliation":[{"name":"From the Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea (S.K., D.P., J.L., W.K., S.L., Y.K., C.W.L., S.-W.P., S.-J.P.); Cardiovascular Research Foundation, New York, NY (G.S.M.); and the Division of Cardiovascular Medicine, Wakayama Medical University, Japan (T.A.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Duk-Woo","family":"Park","sequence":"additional","affiliation":[{"name":"From the Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea (S.K., D.P., J.L., W.K., S.L., Y.K., C.W.L., S.-W.P., S.-J.P.); Cardiovascular Research Foundation, New York, NY (G.S.M.); and the Division of Cardiovascular Medicine, Wakayama Medical University, Japan (T.A.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jong-Young","family":"Lee","sequence":"additional","affiliation":[{"name":"From the Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea (S.K., D.P., J.L., W.K., S.L., Y.K., C.W.L., S.-W.P., S.-J.P.); Cardiovascular Research Foundation, New York, NY (G.S.M.); and the Division of Cardiovascular Medicine, Wakayama Medical University, Japan (T.A.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Won-Jang","family":"Kim","sequence":"additional","affiliation":[{"name":"From the Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea (S.K., D.P., J.L., W.K., S.L., Y.K., C.W.L., S.-W.P., S.-J.P.); Cardiovascular Research Foundation, New York, NY (G.S.M.); and the Division of Cardiovascular Medicine, Wakayama Medical University, Japan (T.A.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seung-Whan","family":"Lee","sequence":"additional","affiliation":[{"name":"From the Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea (S.K., D.P., J.L., W.K., S.L., Y.K., C.W.L., S.-W.P., S.-J.P.); Cardiovascular Research Foundation, New York, NY (G.S.M.); and the Division of Cardiovascular Medicine, Wakayama Medical University, Japan (T.A.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Young-Hak","family":"Kim","sequence":"additional","affiliation":[{"name":"From the Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea (S.K., D.P., J.L., W.K., S.L., Y.K., C.W.L., S.-W.P., S.-J.P.); Cardiovascular Research Foundation, New York, NY (G.S.M.); and the Division of Cardiovascular Medicine, Wakayama Medical University, Japan (T.A.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cheol","family":"Whan Lee","sequence":"additional","affiliation":[{"name":"From the Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea (S.K., D.P., J.L., W.K., S.L., Y.K., C.W.L., S.-W.P., S.-J.P.); Cardiovascular Research Foundation, New York, NY (G.S.M.); and the Division of Cardiovascular Medicine, Wakayama Medical University, Japan (T.A.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seong-Wook","family":"Park","sequence":"additional","affiliation":[{"name":"From the Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea (S.K., D.P., J.L., W.K., S.L., Y.K., C.W.L., S.-W.P., S.-J.P.); Cardiovascular Research Foundation, New York, NY (G.S.M.); and the Division of Cardiovascular Medicine, Wakayama Medical University, Japan (T.A.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seung-Jung","family":"Park","sequence":"additional","affiliation":[{"name":"From the Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea (S.K., D.P., J.L., W.K., S.L., Y.K., C.W.L., S.-W.P., S.-J.P.); Cardiovascular Research Foundation, New York, NY (G.S.M.); and the Division of Cardiovascular Medicine, Wakayama Medical University, Japan (T.A.)."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199602293340903"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.76.2.450"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.98.3.224"},{"key":"e_1_3_3_5_2","first-page":"1281","article-title":"Outcome of percutaneous hybrid coronary revascularization: Bare metal stents jeopardize the benefit of sirolimus-eluting stents in the real world","volume":"21","author":"Fineschi M","year":"2005","unstructured":"Fineschi M, Gori T, Pierli C, Casini S, Sinicropi G, Buti A, Del Pasqua A, Bravi A. 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