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.
Highlights
Coronary artery disease (CAD) remains the leading cause of mortality and morbidity worldwide, albeit with many advances in diagnosis and treatment [1]
The survival rate of patients with CAD has been continuously improving in the last years due to the development and improvement of revascularization therapies, including percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) [2]
Both treatments could be burdened by the activation of accelerated atherosclerosis, which may occur within months to years and lead to revascularization failure associated with unfavorable long-term follow-up outcomes [3]
Summary
Coronary artery disease (CAD) remains the leading cause of mortality and morbidity worldwide, albeit with many advances in diagnosis and treatment [1]. The survival rate of patients with CAD has been continuously improving in the last years due to the development and improvement of revascularization therapies, including percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) [2]. Both treatments could be burdened by the activation of accelerated atherosclerosis, which may occur within months to years and lead to revascularization failure associated with unfavorable long-term follow-up outcomes [3]. Since the introduction of coronary angioplasty about forty years ago, in-stent restenosis (ISR) and de novo neo-atherosclerosis (NA) have been recognized as major causes of lonSgin-tceermthePiCntIrfoadiluucrteio, ntoogfectohreornwariythanlagtieopstleansttythabroomutbfoosritsy [y4e]a. TThheeuunnddeerrlylyininggppatahthopophyhsyisoiloolgoigciaclaml mecehcahnainsmisms osf oISfRISaRndanNdANaAre caoremcpolemxpalnedx saingdnsiifgincaifinctalyntdlyiffdeirfefenrtefnrtofmromthothseosceaucasuinsginngantiavteivaetahtehreorsocslcelreorsoissis(F(iFgiugurere1)1.).InInddeeeded, ,ccoommpprree-hheennssiivvee kknnoowwlleeddggee ooff aallll tthheessee cceelllluullaarr aanndd mmoolleeccuullaarr ppaatthhwwaayyss aarree ffuunnddaammeennttaall aallssoo ttoo ssttiimmuullaatteeffuurrtthheerrrreesseeaarrcch oonn novel molecular targets to prevent this complication [7].
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