Neoatherosclerosis: mirage of an ancient illness or genuine disease condition?: Figure 1

This editorial refers to ‘The association between in-stent neoatherosclerosis and native coronary artery disease progression: a long-term angiographic and optical coherence tomography cohort study’†, by M. Taniwaki et al., on page 2167. In-stent neoatherosclerosis has become the darling of the interventional cardiology community and is blamed for most stent thrombosis (ST) occurring late after drug-eluting stent (DES) implantation. Neoatherosclerosis accounted for only 33% of late and very late ST at autopsy following implantation of first-generation DES.1 However, the clinical prevalence of neoatherosclerosis and its percentage of cases presenting with late and very late ST remains unknown. In the current issue of the journal, Taniwaki et al. propose a significant and biologically relevant association between the presence of in-stent neoatherosclerosis and the progression of native atherosclerosis in a cohort of 88 patients included in the SIRTAX LATE OCT study 5 years following DES implantation.2 The primary clinical endpoint of this study was the occurrence of any non-target lesion revascularization (non-TLR), not accounting for any revascularization procedures within the target lesion, i.e. DES segment. The authors report a frequency of neoatherosclerosis of 15.9% in lesions treated with either paclitaxel-eluting (PES) or sirolimus-eluting stents (SES), which was significantly greater in PES than SES (22.5% vs. 4.9%, P = 0.009). Neoatherosclerosis was defined as fibroatheroma or fibrocalcific plaque within the neointimal tissue based on the standard optical coherence tomography (OCT) definition of attenuated lipid-rich and calcified plaque.3 The authors report plaque progression in both groups, i.e. with or without neoatherosclerosis (change of percentage stenosis diameter: 6.0% in those with vs. 4.3% in those without neoatherosclerosis), with a highly significant difference in the rates of non-TLR up to 5 years in those with neoatherosclerosis vs. those without (79% vs. 45%, P = 0.006).