Serial Intravascular Ultrasound Study Research Articles

Cardiovascular events as a № 1 killer. Pharmacotherapy of coronary heart disease

Cardiovascular events as a № 1 killer. Pharmacotherapy of coronary heart disease

Abstract 15260: Higher Levels of Osteoblast-lineage Cells Are Associated With Cardiac Allograft Vasculopathy Progression

Introduction: Cardiac allograft vasculopathy (CAV) is a major determinant of long term graft survival. Endothelial progenitor cells (EPC) expressing osteocalcin (OC) have been linked to atherosclerosis. However, little is known regarding bone-forming osteoblast-lineage (OL) cells, and their role in atherosclerosis and CAV. Methods: Heart transplant patients undergoing serial Intravascular Ultrasound (IVUS) and progenitor cell studies were included in the study. OL cells, defined as cells positive for alkaline phosphatase (AP) and OC, were counted using flow cytometry on the day of baseline IVUS. A follow up IVUS was done 3 years later. Gray-scale and virtual-histology IVUS were used to evaluate vessel size, plaque burden, and plaque composition (fibrous, fibrofatty, necrotic core, calcified). Patients were divided into two groups by the median change (Δ) in necrotic core volume and plaque volume over 3 years. Results: A total of 55 patients (mean age 52±15 years, 65% males) were included. At baseline, median time after transplant was 4.2 years. Average vessel area at baseline and three years were 15.8 ±4.6 and 15.3 ±5.4 mm2, respectively (p=0.32). However, 24/55 patients (44%) had positive remodeling. The number of OL cells was positively correlated with Δvessel (r=0.36, p=0.01) and Δlumen areas. (r=0.30, p=0.02). Patients with greater Δplaque volume and Δnecrotic core volume had higher OL cell levels compared to those with below medians (Δplaque volume: 95 [30,348] vs. 30 [10, 90] OL per 100,000 counts, p=0.01; Δnecrotic core volume: 95 [22.5, 320] vs. 30 [10, 90] OL per 100,000 counts, p=0.03) (Fig. 1A and 1B). Conclusions: The number of OL cells in heart transplant patients correlates with positive vascular remodeling, accompanied by increased lumen area over 3 months. Furthermore, patients with unstable plaque features had higher OL cells, suggesting a possible role in pathologic plaque progression.

Coronary artery echo-attenuated plaques in acute coronary syndromes: a serial intravascular ultrasound imaging study

Abstract Background Echo attenuation of atherosclerotic plaque (EAP) identified with intravascular ultrasound (IVUS) has been shown to correlate with vulnerable plaque morphologies and their presence is predictive of future cardiovascular events. EAP have predominantly been assessed at a single time point and their natural history in the immediate post acute coronary syndrome (ACS) period remains unknown. We aimed to assess this and whether their presence correlated with a more modifiable plaque composition in the immediate post-ACS setting. Methods Serial IVUS imaging was performed in non-culprit vessels of 270 patients undergoing angiogram for ACS and at 3 month follow up. IVUS analysis of plaque burden and EAP was performed. Results Baseline characteristics are described in Table 1. EAP were present at baseline in 62 patients (23%) with these patients more likely to be male (89.1% vs. 76.7%, p=0.03) but no differences in other atherosclerotic risk factors. There was no difference in baseline plaque burden between patients with EAP and those without (Percent atheroma volume [PAV] 38.9% vs. 37.8%, p=0.32). At follow up IVUS change in PAV was not statistically significantly different between patients with baseline EAP and those without (ΔPAV 0.09% vs. −0.36%, p=0.43), and neither was there a difference in the frequency of plaque regressors (42.7% vs 50%, p=0.31). EAP had resolved in 25 patients (40%) within 3 months at the follow up IVUS. Despite contemporary post-ACS therapy 18 patients who had not had EAP present at baseline (9%) developed new EAP at the follow up IVUS. Conclusion EAP were present in a quarter of ACS patients and were not associated with baseline plaque burden or a more modifiable plaque phenotype. In the setting of contemporary ACS treatments the natural history of high risk IVUS plaque characteristics such as EAP is dynamic with significant change even over a 3 month period in the post ACS setting. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): Royal Adelaide Hospital Research Fund AR Clarkson Scholarship

The Development of Cardiac Allograft Vasculopathy Occurs in Early Intimal Thickening and Constrictive Remodeling in Long-Term Period; Long-Term Serial Intravascular Ultrasound Study

The development of cardiac allograft vasculopathy (CAV) is known to be induced by a biphasic process involving early intimal thickening and late constrictive remodeling. However, change of intimal thickening long-term period post heart transplantation (HTx) is still unknown. Our aim of this study was to investigate the change of intimal thickening of CAV long-term period post-HTx. Intravascular ultrasound (IVUS) of coronary arteries were performed at 5 to 12 weeks after HTx (baseline) and repeated annually in all HTx recipients. And we reviewed the medical records of consecutive 102 HTx recipients who underwent serial intravascular ultrasounds from baseline to at least 1-year post HTx. 'Progressive intimal thickening on IVUS' was defined as an annual increase in maximal intimal thickness (MIT) of 0.3 mm or greater. The development of CAV included the any coronary revascularization, acute myocardial infarction and the coronary artery lesions classified ISHLT CAV 1 or 2. The progressive intimal thickening on IVUS was high incidence by 3 years post-HTx, however, was low after 3 years post-HTx (Figure 1). Also, similar trends were shown regardless of initiation of everolimus. The incidence of progressive intimal thickening on IVUS was higher in the early period than in the mid-term period (92.3% vs 25.0%, P<0.001). While, cumulative event free rate of the development of CAV was linearly decreasing until 10 years after HTx (Figure 2). This long-term serial IVUS study supported that lumen loss on CAV occurred in a biphasic process consisting of the early intimal thickening and late constrictive remodeling. These results suggest that interventions to suppress an increase in intimal thickening is earlier needed within 3 years post-HTx, and also further treatment strategy to suppress the late constrictive remodeling on CAV are required.

Clinical significance of non-culprit plaque regression following acute coronary syndrome: A serial intravascular ultrasound study

BackgroundThe use of serial intravascular ultrasound (IVUS) for coronary atherosclerosis has offered valuable insight into plaque regression (PR) or progression. However, the beneficial effects of PR on the long-term clinical outcomes in patients with acute coronary syndrome (ACS) remain unclear. We aimed to evaluate the impact of coronary plaque change in patients following primary percutaneous coronary intervention. MethodsWe retrospectively analyzed data from 4 prospective clinical trials involving 173 patients with ACS who underwent serial IVUS of non-culprit lesions on statin treatment at baseline and at 6 or 8 months of follow-up. The relationship of the IVUS findings with the change in percent atheroma volume (PAV), on-treatment low-density lipoprotein cholesterol (LDL-C), and major adverse cardiac and cerebrovascular events (MACCE) were investigated. ResultsIn our serial IVUS analysis, baseline plaque volume and PAV were 79.6mm3 and 46.0%, respectively. The overall change in PAV was −1.5% [interquartile range (IQR): −4.1% to 1.0%], and PR (i.e. PAV change from baseline <0) was observed in 67.1% of patients. They were followed up observationally for a mean of 3.5 years and a total of 37 MACCE occurred. The rate of MACCE tended to be lower in patients with PR than in those without PR (18.1% vs. 28.7%, p=0.14). A multivariate Cox hazard model analysis demonstrated that achievement of both PR and on-treatment low LDL-C levels (<70mg/dL) was the only significant independent predictor of MACCE (hazard ratio: 0.42, 95% confidence interval: 0.19–0.88; p=0.02). ConclusionsAchievement of both PR and sufficient lowering of the LDL-C was clinically important in post-ACS management.

Distal radial arterial hypertrophy after transradial intervention: A serial intravascular ultrasound study

BackgroundTransradial intervention (TRI) may cause damage to the radial artery (RA). We have demonstrated intima-media thickening and luminal narrowing of the distal RA after TRI using intravascular ultrasound (IVUS). This study aimed to determine the predictors of intima-media thickening of RA after TRI in the same patients using serial IVUS. Methods and resultsWe enrolled 110 consecutive patients who underwent TRI. IVUS of RA was immediately performed after TRI and repeated 6 months later. Volumetric analyses were performed for the distal RA. The intima-media volume (IMV) increased from 53.56±10.85mm3 to 58.70±13.04mm3 (p=0.0022), whereas the lumen volume (LV) decreased from 146.87±40.53mm3 to 129.64±45.78mm3 (p=0.0018) and vessel volume (VV) decreased from 201.23±44.55mm3 to 188.34±52.25mm3 (p=0.0306). Multiple regression analysis revealed diabetes as the most powerful independent predictor of the percentage change in IMV of the distal RA after TRI. The percentage change in IMV significantly increased in the DM group compared with non-DM group (p<0.001). The percentage change in IMV was significantly positively correlated with HbA1c. ConclusionsSerial IVUS of the distal RA revealed a significant increase in IMV and decreases in LV and VV. Diabetes was the most powerful independent predictor of the percentage change in IMV of the distal RA after TRI. The percentage change in IMV was significantly positively correlated with HbA1c.

GW28-e0381 OCT-derived Macrophage and Progression of Lipid Rich Plaque: A serial OCT and IVUS study

Inflammation plays a pivotal role in the pathophysiology of plaque formation and progression. Optical coherence tomography (OCT) allows high-resolution imaging of tissue microstructure. Intravascular ultrasound (IVUS) has been widely used to serially study plaque progression in relation to various

Chronic vascular response after self-expanding nitinol stent implantation in superficial femoral arteries: a serial intravascular ultrasound analysis

The mechanical properties of the self-expanding nitinol stents (SENS) and chronic biological stimulation on the wall from the SENS have not been fully investigated. This study evaluated the mechanical vascular response to SENS implantation in superficial femoral artery (SFA) lesions using serial volumetric intravascular ultrasound (IVUS). Twenty-five symptomatic patients due to de novo SFA lesions scheduled for SENS placement were prospectively enrolled. Serial IVUS studies were performed immediately after crossing with a guidewire, immediately after the procedure, and at a 8-month follow-up. Serial IVUS volumetric analysis was conducted after stent deployment and at follow-up. Mean stent, lumen and neointimal areas were calculated as the volume divided by the stent length, and the calcium arc was measured. At follow-up, SENS had increased 40.6% in overall volume. The chronic stent expansion tended to be larger, and the mean neointimal area at the 8-month follow-up was significantly larger in less calcified lesions compared to heavily calcified lesions. As a result, the mean late lumen area loss was significantly larger in lesions with calcium arcs of 0° and in the first and second quadrants than in those with calcium arcs in the third and fourth quadrants (2.8±7.2, 1.3±5.6, 0.6±5.9, 1.2±5.4, -0.8±5.2 mm(2), respectively; p<0.001). SENSs continued to enlarge with intimal proliferation over 8months in all lesions. Although arterial calcium affected the degree of chronic stent expansion during the follow-up period, neointimal proliferation was smaller in heavily calcified lesion compared to less calcified lesion following SENS implantation.

Positive remodeling at 3 year follow up is associated with plaque free coronary wall segment at baseline: A serial IVUS study

AimsAt present it is unknown what limits the arterial remodeling process during atherosclerotic plaque formation. In healthy arteries remodeling is regulated by the shear stress induced response by the endothelium. As endothelium at the plaque site is assumed to be dysfunctional, we tested the hypothesis that plaque free wall (PFW) determines vascular remodeling during atherosclerotic plaque build-up. Methods & results66 human coronary ROIs (38 patients) were studied at baseline and at 3 years follow up applying intravascular ultrasound (IVUS). From the IVUS images the lumen and external elastic membrane contours were delineated to assess wall thickness (WT), vessel area (VA), Plaque Area (PA) and plaque burden (PA/VA*100%). WT < 0.5 mm was defined as normal and determined the arc of the PFW (0–360°). Positive remodeling was defined as relative difference of VA over time >5%. At baseline, IVUS-PFW was inversely related to plaque burden (p < 0.05). Positive remodeling was most frequently observed in ROIs with IVUS-PFW > 180° (i.e. larger than half of the circumference) compared to PFW < 180° (55% vs. 12%, p < 0.05). Accordingly, plaques with IVUS-PFW > 180° at baseline had the largest change in VA (1.1 ± 2.1 vs. −0.4 ± 0.6 mm2, p < 0.05) with an odds ratio of 9.2 to develop positive remodeling. ConclusionsOur serial IVUS data show that IVUS-PFW is a determinant of vascular remodeling. ROIs with PFW > 180 at baseline had the highest probability to undergo positive remodeling.

Serial intravascular ultrasound assessment of very late stent thrombosis after sirolimus-eluting stent placement

PurposeIn-stent restenosis has been decreasing through the introduction of drug-eluting stents (DES). On the other hand, adverse events such as very late stent thrombosis (VLST) and late catch-up phenomenon can occur especially with sirolimus-eluting stents (SES, first-generation DES) in long-term follow-up. However, the precise mechanisms underlying VLST have not been well investigated in vivo. Methods and resultsFrom 2004 to 2010, 2034 SES were implanted in 1656 patients and caused eight VLST (0.48% per patient) at Fukuoka Tokushukai Medical Center. Of these, serial intravascular ultrasound (IVUS) images (post-stent implantation and at the time of VLST onset) were obtained from three patients with VLST. Comparing them with eight control patients with SES implanted, the vascular reactivity of VLST patients was analyzed. Eight VLST happened 50±15 months after stent implantation and three of the eight patients with VLST had not taken aspirin daily. There were no differences in minimum stent area, maximum external elastic membrane (EEM) area, and stent edge (distal and proximal) EEM area in post-procedural IVUS images. Compared with the control group patients, ΔEEM area (10.6±3.4mm2 vs. 1.7±1.9mm2, p=0.01) and vessel expansion ratio (185.6±40.3% vs. 112.0±12.1%, p=0.01) were significantly greater in the VLST group based on the greater peri-stent plaque expansion (262.1±72.8% vs. 118.7±21.2%, p=0.01). ConclusionOur serial IVUS study showed that the vascular positive remodeling after SES implantation is one of the most probable morphological mechanisms for VLST development.

Implications of age in coronary artery disease progression. A serial, volumetric, intravascular ultrasound study

Background: The implications of age on clinical and angiographic manifestations of coronary artery disease are well established. Elderly Patients (P) are classically under-represented in clinical trials and are less likely to be fully investigated and to receive well established therapies. However, the potential influence of age on atherosclerosis progression remains poorly defined. Objective: The purpose of this study was to determine the relationship between age and the extent of coronary atherosclerosis and its progression rate. Methods: 200 consecutive P (mean age 65±10 years, 45 [22%] female) undergoing Serial Intravascular Ultrasound (IVUS) studies (median time interval 366 days) were analyzed. Of these, 39 P (19,5%) were ≥ 75 years of age (elderly). A validated system for volumetric IVUS analysis (EchoScan, TOMTEC) was used for off-line three-dimensional reconstruction and volumetric analysis. Both age groups were compared with regard to baseline characteristics, coronary atheroma burden, and disease progression at follow-up. Study end-points were absolute and percent change (delta) in plaque volume as detected by IVUS. Results: Elderly P had a more adverse cardiovascular risk profile, including diabetes and hypertension. Despite this adverse clinical profile, medical therapy was similar in both groups. However, baseline Total Atheroma Volume (TAV) and Percent AtheromaVolume (PAV) were similar in both groups. Furthermore, at late follow-up, changes in TAV and PAV were also similar in both groups. View this table: Table 1. Clinical characteristics and changes in atheroma burden according to age Conclusions: Despite an adverse clinical profile elderly P with established coronary artery disease have a similar extent of coronary atheroma burden than younger P. Coronary atheroma progression is also similar in both age groups, emphasizing the need for implementing of aggressive preventive therapeutic strategies irrespective of P age.

Assessment of plaque evolution in coronary bifurcations located beyond everolimus eluting scaffolds: serial intravascular ultrasound virtual histology study

PurposeTo evaluate the atherosclerotic evolution in coronary bifurcations located proximally and distally to a bioresorbable scaffold.MethodsThirty bifurcations located >5 mm beyond the scaffolded segment, being investigated with serial intravascular ultrasound virtual histology (IVUS-VH) examinations, at baseline and 2-years, in patients enrolled in the ABSORB cohort B1 study were included in this analysis. In each bifurcation, the frames portraying the proximal rim, in-bifurcation, and distal rim of the ostium of the side branch were analyzed. The geometric parameters and plaque types were evaluated at baseline and 2-years follow-up.ResultsThere were no significant differences in the geometrical parameters such as lumen, vessel and plaque areas as well as in the composition of the atheroma between baseline and 2-years follow-up.When we separately examined the bifurcations located proximally and distally to the scaffolded segment, no changes were found at the distal bifurcations, while at the proximal bifurcations there was a statistical significant decrease in the plaque burden (36.67 ± 13.33% at baseline vs. 35.06 ± 13.20% at 2 years follow-up, p = 0.04).Ten necrotic core rich plaques were found at baseline, of which 2 regressed to either fibrotic plaque or to intimal thickening at 2 years follow-up. The other 8 did not change. Disease progression was noted in 3 plaques (1 adaptive intimal thickening, 1 fibrotic and 1 fibrocalcific plaque) that evolved to necrotic rich plaques.ConclusionsPlaque regression was noted at the bifurcations located proximally to the bioresorbable scaffold but not at these located distally. Additional studies are required to confirm this finding and examine further the effect of drug elution on atherosclerotic evolution.

TCT-274 Relationship Between Arterial Remodeling, Fibrous Cap Thinning and Lipid Accumulation: A Serial Integrated Backscatter Intravascular Ultrasound and Optical Coherence Tomography Study

A serial intravascular ultrasound (IVUS) and optical coherence tomography (OCT) study has shown that positive arterial remodeling was related to thinning of fibrous cap. Serial changes in tissue components associated with fibrous cap and/or arterial remodeling is unknown Therefore, the purpose of

Is size really all that matters? Remarks on size and necrotic core content of atherosclerotic plaques

Is size really all that matters? Remarks on size and necrotic core content of atherosclerotic plaques

Disease Progression in Nonintervened Saphenous Vein Graft Segments: A Serial Intravascular Ultrasound Analysis

We used serial intravascular ultrasound (IVUS) to assess disease progression in nonintervened saphenous vein graft (SVG) segments to determine the natural rate of disease progression in SVG. There are no serial IVUS studies of disease progression or luminal compromise in SVGs. We assessed serial (baseline and follow-up at 16.2 +/- 7.4 months) IVUS findings in 50 nonintervened SVG segments in 44 patients. The SVG age was 13.5 +/- 3.6 years. Overall, from baseline to follow-up, plaque area increased (Delta = +0.58 +/- 1.25 mm(2), p = 0.003), and SVG and minimum lumen area (MLA) decreased (Delta = -0.50 +/- 1.14 mm(2), p = 0.002, and Delta = -1.08 +/- 1.28 mm(2), p < 0.001, respectively). The MLA decreased in 34 lesions (Delta = -1.67 +/- 1.08 mm(2)), and MLA increased in 16 lesions (Delta = +0.19 +/- 0.47 mm(2)). Compared with lesions with an increase in MLA, lesions with a decrease in MLA were associated with: 1) larger baseline SVG and plaque areas and plaque burden (15.57 +/- 3.90 mm(2) vs. 11.55 +/- 2.30 mm(2), p < 0.001; 7.97 +/- 3.77 mm(2) vs. 4.27 +/- 1.92 mm(2), p < 0.001; and 48.7 +/- 14.2% vs. 36.0 +/- 13.4%, p = 0.004, respectively); and 2) a greater decrease in SVG area (Delta = -0.96 +/- 1.05 mm(2) vs. +0.48 +/- 0.58 mm(2), p < 0.001) and greater increase in plaque area (Delta = +0.71 +/- 1.47 mm(2) vs. +0.29 +/- 0.45 mm(2), p < 0.001). The DeltaMLA correlated with both Deltaplaque area (r = -0.589, p < 0.001) and DeltaSVG area (r = 0.470, p = 0.001), and Deltaplaque area correlated with DeltaSVG area (r = 0.436, p = 0.002). There were linear relations between both the Deltaplaque area (r = 0.519, p < 0.001) and Deltalumen area (r = -0.500, p < 0.001) versus follow-up low-density lipoprotein (LDL) cholesterol; a follow-up LDL cholesterol of 100 mg/dl predicted no plaque increase. Lumen loss in nonintervened SVG segments correlated with an increase in plaque area and a decrease in SVG area (plaque growth and negative remodeling) with a linear relationship between plaque growth versus follow-up LDL cholesterol leading to long-term lumen loss.

Abstract 3211: Diabetes is Associated with Greater Progression of Coronary Atherosclerosis than the Metabolic Syndrome: Insights from Serial Intravascular Ultrasound Studies

Background: While the metabolic syndrome (MetS) and diabetes (DM) share many pathophysiological features it remains to be determined if they influence coronary atherosclerotic disease progression to a similar degree. Methods : A systematic review of subjects participating in 7 clinical trials that monitored coronary atheroma progression with intravascular ultrasound was performed. Clinical characteristics, baseline atheroma burden and disease progression were compared in patients with the MetS (n=1119), DM (n=201) or their combination (n=878). Results: Patients with the MetS were younger, more likely to be female and had a greater risk factor burden than diabetics. At baseline the presence of DM was associated with a greater percent atheroma volume (PAV 41.0+/−8.5 vs 37.6+/−8.9 %, p&lt;0.001) and total atheroma volume (TAV 202.5+/−84.1 vs 190.73+−84.9 mm 3 , p&lt;0.001) than observed in patients with the MetS. Greater progression of PAV (+0.71+/−0.3 vs 0.28+/−0.2 % p=0.04) and TAV (−3.3+/−1.8 vs −1.0+/−2.1 mm 3 , p=0.1) was observed in the presence of DM compared with the MetS. The combination of MetS and DM was not associated with greater PAV (+0.82+/−0.2 vs +0.71+/−0.3 %, p=0.59) or TAV (−1.0+/−1.8 vs −1.0+/−2.1 mm 3 , p=0.98) than DM alone. Substantial progression rate were not differ between three groups (Table ). However, the combination of DM and the MetS did result in the lowest rate of patients undergoing substantial plaque regression (&gt;.0 % chg in PAV, 14.9% vs 18.4%, p=0.01) when compared with patients with DM, not meeting the criteria for the MetS. Conclusions: Despite the presence of more risk factors, meeting the criteria for the MetS is not associated with a greater rate of progression of coronary atherosclerosis in patients with DM. This highlights the accelerated nature of disease in the setting of established DM. Table. Baseline and changes in IVUS disease burden according to metabolic syndrome and diabetes

Glucocorticoids in the prevention of in-stent restenosis: The role of inflammation

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Do the extent and direction of arterial remodelling predict subsequent progression of coronary atherosclerosis? A serial intravascular ultrasound study

Objective: Despite the link between positive coronary remodelling and acute ischaemic events, no data exist about the impact of arterial remodelling on subsequent progression of coronary atherosclerosis. The objective of...

Arterial remodelling: an independent pathophysiological component of atherosclerotic disease progression and regression. Insights from serial pharmacological intervention trials

Rodriguez-Granillo et al. 1 report arterial remodelling data from the ‘PERSPECTIVE’ study,2 an imaging substudy of the ‘EUROPA’ study.3 ‘EUROPA’ is a randomized, placebo-controlled, multicentre trial, which demonstrated that the angiotensin-converting enzyme (ACE) inhibitor perindopril reduced adverse clinical events in 12 218 patients with stable coronary artery disease (CAD). The EUROPA investigators suggested that the clinical benefit is related to anti-atherosclerotic effects of ACE inhibitors. However, the ‘PERSPECTIVE’ substudy, which examined the impact of perindopril on atherosclerosis in a subset of 118 patients, found neither an effect on plaque burden assessed by intravascular ultrasound (IVUS) nor an effect on angiographic luminal diameter. The lack of change in these imaging end-points could indicate that the clinical benefit of ACE inhibition is not mediated by changes of atherosclerotic plaque anatomy. However, an alternative explanation is that ACE inhibition exerts other plaque-stabilizing effects including modification of plaque composition and arterial remodelling. This hypothesis is examined in the current, serial IVUS study, which investigates the effect of perindopril on arterial remodelling and plaque composition. Remodelling was defined as a relative increase (expansive remodelling) or decrease (constrictive remodelling) of the mean vessel cross-sectional area (CSA) between baseline and follow-up. A total of 711 matched 5 mm segments from 118 IVUS examinations were available at baseline and after 3-year follow-up. There was no significant difference in the change of plaque burden between the perindopril and placebo groups. However, the … *Corresponding author. Tel: +1-216-445-7579. E-mail address: schoenp1{at}ccf.org

Late incomplete apposition after drug-eluting stent implantation: incidence and potential for adverse clinical outcomes

Late-acquired incomplete stent apposition (ISA) has been documented after drug-eluting stent (DES) implantation; however, its clinical role remains controversial. We sought to investigate the incidence and long-term clinical consequences of late ISA after implantation of sirolimus- (SES) or paclitaxel-eluting stent (PES) in a non-selected population. From our database, we analysed 195 consecutive patients who underwent DES placement (175 with SES and 20 with PES) into native artery lesions and had serial intravascular ultrasound studies (IVUS) performed at index procedure and after 6-8 months. They were clinically followed for 29 +/- 15 months (median of 24.3 months, interquartile range 18.1-31.6 months). Late ISA was defined as separation of at least one stent strut from the vessel wall in a segment without a side-branch and where the immediate post-implantation IVUS revealed complete apposition of stent struts. We identified 10 patients (5.1%) with late ISA, three patients after PES, and seven patients after SES implantation. ISA was localized almost exclusively at body of the stents (nine out of 10 cases). Mean ISA volume and length were 44.5 +/- 41.9 mm(3) and 7.4 +/- 11 mm, respectively. There was a marked increase in vessel volume from 416.0 +/- 163.9 mm(3) at baseline to 514.4 +/- 247.9 mm(3) at follow-up (P = 0.001) with no significant change in plaque volume (232.4 +/- 52.7 at baseline and 226.4 +/- 22.3 mm(3) at follow-up, P = 0.3) in patients who presented with late-acquired ISA. During the follow-up period, one patient with SES and one patient with PES who presented late-acquired ISA had late stent thrombosis and acute myocardial infarction. Late-acquired ISA was observed in 5.1% of patients after DES implantation and is related to regional vessel positive remodelling. The relationship between late-acquired ISA and long-term adverse outcomes (e.g. stent thrombosis) requires further analysis.