Neovascularization restructuring patterns in diabetic patients with coronary in stent restenosis an in-vivo optical coherence tomography study

Abstract

Abstract Background Patients with diabetes mellitus (DM) have an increased risk of in stent restenosis (ISR). Neovascularization (NV) is considered as a unique phathophysiological factor of ISR in diabetic patients. However, the structures of in vivo human coronary NV and their relationship with ISR, especially in diabetic patients remain unclear. In this study, we aimed to investigate the NV structure differentiation between patients with and without DM after coronary stent implantation using optical coherence tomography (OCT). Methods We included 136 patients with ISR (70 patients in DM group and 66 patients in non-DM group) who underwent optical coherence tomography during coronary angiography follow-up. NVs were manually segmented and three-dimensional (3D) rendering of OCT images was performed. NVs >1 mm were classified into longitudinal running and coral tree types according to their 3D structures. Results The popularity of the coral tree pattern NV in the DM group was 2.14-fold higher than in the non-DM group(p=0.012). 47.14% of patients in the DM group and 51.51% of patients in the non-DM group presented longitudinal NV (p = 0.610). The number of coral tree NV was relatively higher in DM patients than in the non-DM patients (p=0.019). However, the number of longitudinal NV showed no difference between the two group (p=0.872). The normalized NV volume of the DM group was significantly larger than the non-DM group (p=0.008). Normalized NV volume and DM were risk factors for coral tree NV formation in ISR lesions after adjustment for other factors. Conclusions NV with particular restructuring patterns, including longitudinal running and coral tree patterns, could be found in ISR lesions. NV with a coral tree pattern, which is leakier and more immature, is more frequently found in patients with DM. Accurate and feasible imaging modalities for NV might offer promising opportunities to evaluate NV and prevent progression of ISR in diabetic patients.Longitudinal running NV by OCT in neointA coral tree pattern NV in the non-calci