Assessment of and Factors Contributing to Adequate Endothelization After Drug-Eluting Stent Implantation
Abstract
BACKGROUND: Adequate endothelization after drug-eluting stent (DES) implantation is essential to reduce thrombotic risk. Adequate strut coverage (ASC) is defined as ≥40 μm on optical coherence tomography, but its functional significance remains uncertain. Coronary angioscopy can assess neointimal function by detecting thrombus and plaque color. This study evaluated functionally adequate endothelization and contributing factors after DES implantation. METHODS AND RESULTS: Post hoc analyses of the COLLABORATION 1 and 2 studies were performed using serial optical coherence tomography and coronary angioscopy 1 and 12 months after DES implantation. Four DES types were examined: durable polymer everolimus-eluting stent (DP-EES); sirolimus-eluting stent (SES); polymer-free biolimus-coated stent (PF-BCS); and dual-therapy sirolimus-eluting stent (DTS). PF-BCS and DTS were classified as "ingenious" DES, and DP-EES and SES were classified as "fundamental." The correlation between the percentage of struts with ≥40 μm coverage (%ASC) and functional neointima (i.e., no thrombus and white plaque) was assessed. Among 150 patients (177 lesions), thrombus and yellow plaque were inversely correlated with %ASC at 12 months. Cut-off values of %ASC were 67% for thrombus prevention and 90% for plaque stabilization. Multivariable analysis identified the use of ingenious DES, prasugrel therapy, and hypertension as independent predictors of chronic adequate endothelization. CONCLUSIONS: Functional protection against thrombus requires %ASC ≥67%, and plaque stabilization requires ≥90%. The use of ingenious DESs and prasugrel contributes to improved chronic adequate endothelization.
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BibTeX
@article{nishino2026assessment,
title = {{Assessment of and Factors Contributing to Adequate Endothelization After Drug-Eluting Stent Implantation}},
author = {Masami Nishino and Yasuyuki Egami and Hiroaki Nohara and Shodai Kawanami and Koji Yasumoto and Naotaka Okamoto and Yasuharu Matsunaga-Lee and Masamichi Yano and Tatsuya Shiraki and Daisuke Nakamura and Isamu Mizote and Takayuki Ishihara and Toshiaki Mano and Takahisa Yamada and Naoki Itaya and Takaharu Nakayoshi and Takafumi Ueno and Daisaku Nakatani and Shungo Hikoso and Shinsuke Nanto and Yasushi Sakata},
journal = {Circulation Journal},
year = {2026},
month = jul,
doi = {10.1253/circj.cj-25-1123},
url = {https://www.jstage.jst.go.jp/article/circj/90/8/90_CJ-25-1123/_article},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Assessment of and Factors Contributing to Adequate Endothelization After Drug-Eluting Stent Implantation
AU - Masami Nishino
AU - Yasuyuki Egami
AU - Hiroaki Nohara
AU - Shodai Kawanami
AU - Koji Yasumoto
AU - Naotaka Okamoto
AU - Yasuharu Matsunaga-Lee
AU - Masamichi Yano
AU - Tatsuya Shiraki
AU - Daisuke Nakamura
AU - Isamu Mizote
AU - Takayuki Ishihara
AU - Toshiaki Mano
AU - Takahisa Yamada
AU - Naoki Itaya
AU - Takaharu Nakayoshi
AU - Takafumi Ueno
AU - Daisaku Nakatani
AU - Shungo Hikoso
AU - Shinsuke Nanto
AU - Yasushi Sakata
PY - 2026
DA - 2026/07/24
JO - Circulation Journal
DO - 10.1253/circj.cj-25-1123
UR - https://www.jstage.jst.go.jp/article/circj/90/8/90_CJ-25-1123/_article
AB - BACKGROUND: Adequate endothelization after drug-eluting stent (DES) implantation is essential to reduce thrombotic risk. Adequate strut coverage (ASC) is defined as ≥40 μm on optical coherence tomography, but its functional significance remains uncertain. Coronary angioscopy can assess neointimal function by detecting thrombus and plaque color. This study evaluated functionally adequate endothelization and contributing factors after DES implantation. METHODS AND RESULTS: Post hoc analyses of the COLLABORATION 1 and 2 studies were performed using serial optical coherence tomography and coronary angioscopy 1 and 12 months after DES implantation. Four DES types were examined: durable polymer everolimus-eluting stent (DP-EES); sirolimus-eluting stent (SES); polymer-free biolimus-coated stent (PF-BCS); and dual-therapy sirolimus-eluting stent (DTS). PF-BCS and DTS were classified as "ingenious" DES, and DP-EES and SES were classified as "fundamental." The correlation between the percentage of struts with ≥40 μm coverage (%ASC) and functional neointima (i.e., no thrombus and white plaque) was assessed. Among 150 patients (177 lesions), thrombus and yellow plaque were inversely correlated with %ASC at 12 months. Cut-off values of %ASC were 67% for thrombus prevention and 90% for plaque stabilization. Multivariable analysis identified the use of ingenious DES, prasugrel therapy, and hypertension as independent predictors of chronic adequate endothelization. CONCLUSIONS: Functional protection against thrombus requires %ASC ≥67%, and plaque stabilization requires ≥90%. The use of ingenious DESs and prasugrel contributes to improved chronic adequate endothelization.
SN - 1347-4820
SN - 1346-9843
ER -