类细胞膜仿生药物缓释涂层冠状动脉支架材料

背景:金属冠状动脉支架植入后发生再狭窄的概率高达20%～30%,为了降低再狭窄发生率,在863项目支持下,探索新型药物涂层支架治疗冠状动脉狭窄的可能性.目的:将约物涂层支架植入小猪冠状动脉狭窄模型,观察其安全性和有效性,以及与金属裸支架的差异性.设计、时间及地点:随机对照,动物实验于2003-11/2004-04在阜外心血管病医院完成.材料:由单体2-(甲基丙烯酰氧基)乙基-2-(三甲基氨基)乙基磷酸酯、甲基丙烯酸十八酯、甲基丙烯酸羟丙酯和甲基丙烯酸(三甲氧)硅基丙酯合成了一种新型类细胞膜涂层材料.方法:21只猪随机分为3组:裸支架组,涂层携载雷帕霉素(120 μ g,支架)组,单纯涂层支架组.将支架预装到输送系统,使用Toshiba CSⅡ型C臂成像仪造影条件下,将药物支架置入小型猪冠状动脉血管,每只猪置入2枚支架.主要观察指标:使用图像分析仪检测管腔直径,管腔面积,支架上平均内膜厚度,支架间平均内膜厚度,内膜面积,面积再狭窄百分比,损伤指数.结果:置入后28 d时,涂层携载雷帕霉素组和裸支架组相比,支架上内膜厚度、支架间内膜厚度、新生内膜面积差异均有显著性意义(P＜0.05),其中新生内膜面积涂层携载雷帕霉素组比裸支架组减少了44.87%:虽面积狭窄百分比差异无显著性意义,但P值(0.053)接近0.05;且涂层携载雷帕霉素组无再狭窄发生.结论;涂层携载雷帕霉素支架可显著抑制支架置入后血管内膜增生和再狭窄发生.     

Intracoronary Optical Frequency Domain Imaging for Identifying Stent-Related Complications

Percutaneous coronary intervention is the most common treatment of coronary artery disease with the majority of cases undergoing stent implantation. Furthermore, adequate stent deployment is of primary importance to avoid late stent thrombosis and achieve a favorable clinical outcome. Optical coherence tomography (OCT) is a new imaging modality that utilizes advanced photonics and fiberoptics to obtain intravascular images on a microscopic scale. Today, many new drug-eluting stents (DES) are now undergoing clinical trials. Moreover, the intricacies of stent design, local pharmacology, tissue biology, and rheology preclude an intuitive understanding of usability of DES. After stent implantation, assessment should include both the acute and chronic stent/vessel-related changes which include stent malapposition, tissue prolapse, edge dissections, and thrombus formation. OCT plays an indispensable part in determining mechanistic information on the relevance of these phenomena among each DES that cannot be covered by several other modalities.     

Angioscopic Evaluation of Neointimal Coverage of Coronary Stents

Drug-eluting stents (DES) reduce coronary restenosis significantly; however, late stent thrombosis (LST) occurs, which requires long-term antiplatelet therapy. Angioscopic grading of neointimal coverage of coronary stent struts was established, and it was revealed that neointimal formation is incomplete and prevalence of LST is higher in DES when compared to bare-metal stents. It was also observed that the neointima is thicker and LST is less frequent in paclitaxel-eluting and zotarolimus-eluting stents than in sirolimus-eluting stents. Many new stents were devised and they are now under experimental or clinical investigations to overcome the shortcomings of the stents that have been employed clinically. Endothelial cells are highly anti-thrombotic. Neo-endothelial cell damage is considered to be caused by friction between the cells and stent struts due to the thin neointima between them which might act as a cushion. Therefore, development of a DES that causes an appropriate thickness (around 100 μm) of the neointima is a potential option with which to prevent neo-endothelial cell damage and consequent LST while preventing restenosis.     

Optical Coherence Tomography Imaging: Novel Insights into the Vascular Response After Coronary Stent Implantation

Optical coherence tomography (OCT) is a high-resolution imaging technique that is increasingly used for intracoronary imaging to characterize coronary atherosclerotic plaques and vascular responses after coronary stent implantation. Introduction of optical frequency-domain imaging (OFDI; second generation OCT) has simplified practical use of this novel imaging modality resulting in a more widespread availability in interventional cardiology. Here we highlight recent insights into the acute and chronic vascular response after coronary stent implantation by OCT imaging. OCT provides cross-sectional images with approximately 10-fold higher resolution as compared to intravascular-ultrasound (IVUS), allowing for precise evaluation of tissue coverage and malapposition of coronary stent struts. More than 30 studies using OCT to compare vascular responses to different stents have now been reported. Recent studies have examined the relation between OCT-image characteristics and tissue composition around stent struts. OCT is used for evaluation of novel stent concepts, such as bioengineered stents and bioabsorbable stents, where it provides more accurate information than IVUS. While intracoronary OCT imaging is further developed, including faster 3D-OCT-image-reconstruction, larger OCT studies/registries with standardized analysis will provide more insights into clinical implications of observations from OCT-imaging after coronary stent implantation.     

Drug-eluting stents - what should be improved?

Despite the success of drug-eluting stents (DES) in reducing restenosis and the need for target vessel revascularization, several deficiencies have been unraveled since their first clinical application including the risk of stent thrombosis, undesired effects due to the stent polymer as well as the stent itself, and incomplete inhibition of restenosis (especially in complex lesions). Several novel stent systems are being investigated in order to address these issues. In second-generation DES, the rapamycin analogues zotarolimus and everolimus (and more recently biolimus) have been most extensively studied. Furthermore, special stent-coatings to actively promote endothelial healing (in order to reduce the risk of stent thrombosis) and to further reduce restenosis have been employed. To avoid undesirable effects of currently applied (durable) polymers, biocompatible and bioabsorbable polymers as well as DES delivery systems without the need for a polymer have been developed. Bioabsorbable stents, both polymeric and metallic, were developed to decrease potential late complications after stent implantation. Although most of these innovative novel principles intuitively seem appealing and demonstrate good results in initial clinical evaluations, long-term large-scale studies are necessary in order to reliably assess whether these novel systems are truly superior to first-generation DES with respect to safety and efficacy.     

Rationale and design: Impact of intravascular ultrasound guidance on long-term clinical outcomes of everolimus-eluting stents in long coronary lesions

BackgroundAlthough the use of drug-eluting stents (DESs) in patients with coronary artery disease has contributed to a significant reduction in in-stent restenosis and repeat revascularization, treating diffuse long lesions using DESs remains challenging due to the high rates of in-stent restenosis and stent thrombosis. Intravascular ultrasound (IVUS) provides tomographic images of coronary vascular structure and is useful for evaluating lesion morphology and stent optimization during percutaneous coronary intervention. However, it remains controversial whether IVUS guidance in DES implantation for long coronary lesions could reduce adverse clinical outcomes.HypothesisWe hypothesize that the long-term clinical outcomes of IVUS-guided DES implantation would be superior to those of angiography-guided DES implantation in a subset of patients with long coronary lesions.Study designThis study is a randomized, prospective, multi-center trial comparing the long-term clinical outcomes of IVUS-guided and angiography-guided everolimus-eluting stent implantation in patients with long coronary lesions (implanted stent ≥ 28 mm in length). The primary end point is a composite of major adverse cardiac events, including cardiac death, target lesion-related myocardial infarction, or target lesion revascularization at 1 year following intervention. A total of 1,400 patients will be required to be enrolled according to sample size calculations.ConclusionThis study will test the hypothesis that IVUS guidance improves long-term clinical outcomes in patients treated with everolimus-eluting stents for long coronary lesions compared with angiographic guidance.     

Stent fracture and longitudinal compression detected on coronary CT angiography in the first- and new-generation drug-eluting stents

To evaluated prevalence and clinical implication of stent fracture and longitudinal compression in first- and new-generation drug-eluting stents (DES) using coronary computed tomography angiography (CCTA). The incidence of stent fracture and longitudinal compression were compared between first- and new-generation DES in 374 patients who underwent coronary stenting using DES and follow-up CCTA due to recurrent angina. 235 and 139 patients received 322 first- and 213 new-generation DES, respectively. The crude per-stent incidence of longitudinal compression (6.1 vs. 0.3 %, p < 0.001) was higher after new- than first-generation DES implantation using CCTA and the incidence of stent fracture (11.3 vs. 8.1 %, p = 0.23) was comparable. On follow-up coronary angiography for 347 stents, stent fracture (3.2 %) and longitudinal compression (0.9 %) were less detected than those on CCTA. Ostial stenting was a risk factor of longitudinal compression (p < 0.001). Stent fracture was associated with younger patients (p = 0.03), longer stent (p = 0.010), and excessively tortuous lesions (p = 0.001). The presence of stent fracture or longitudinal compression was not associated with poor clinical outcomes. The longitudinal compression more frequently occurred after new-generation DES implantation. The stent fracture was comparable between two DES. However, the occurrence of such mechanical deformities did not translate into a poor clinical outcome.     

Very early tissue coverage after drug-eluting stent implantation: an optical coherence tomography study

The aim of this study was to evaluate neointimal coverage in the very early phase after second-generation drug-eluting stent (DES) implantation using optical coherence tomography (OCT). Patients who underwent staged percutaneous coronary intervention within 30 days after DES implantation were enrolled. OCT was performed to observe DES previously implanted. The median time interval from implantation to OCT examination was 21.5 days. A total of 10,625 struts of 54 stents (52 everolimus-eluting stents and 2 zotarolimus-eluting stents) in 42 lesions were analyzed. Strut tissue coverage was observed in 71.1?±?19.2?% of the struts, malapposed struts in 2.56?±?3.37?%, strut tissue coverage at the side branch orifice in 10.6?±?17.2?%, and struts with protrusion in 0.95?±?3.46?%. Mean tissue thickness on the covered struts was 39.8?±?14.2 µm. The percentage of stent coverage was significantly lower in the overlapping segments than in the non-overlapping segments (48.4?±?17.5?% vs. 74.4?±?20.2?%, P?<?0.05). Most of the stent struts were covered by tissue within 30 days after second-generation DES implantation. However, the percentage of strut coverage was lower in the overlapping segments than in the non-overlapping segments, suggesting that very early interruption of dual antiplatelet therapy might result in increased risk of stent thrombosis, even in second-generation DES.     

杂交策略治疗冠状动脉慢性完全闭塞病变的有效性和安全性

目的 探讨药物洗脱支架（drug-eluting stent, DES）联用药物涂层球囊（drug-coated balloon, DCB）的杂交策略治疗冠状动脉慢性完全闭塞（chronic total occlusion, CTO）病变的有效性和安全性。方法 连续纳入2021年9月至2022年9月在复旦大学附属中山医院确诊为CTO并采用单纯DES植入或杂交策略治疗的369例患者，分为DES组（n=220）和杂交策略组（n=149）。比较两组患者的临床基线信息、介入手术特征、术后定量冠状动脉造影（quantitative coronary angiography, QCA）参数和定量血流分数（quantitative flow ratio, QFR）。随访术后1个月内主要不良心血管事件（major adverse cardiovascular events, MACE）发生率。结果 369例患者的369个病变以前降支病变（44.7%）和右冠状动脉病变（43.1%）为主。与DES组相比，杂交策略组植入支架数[1.67±0.66 vs 2.00±0.81, P<0.001]和植入支架...     

冠状动脉支架材料与置入后炎症因子的变化

目的：总结冠状动脉支架材料及置入后炎症因子变化的关系。方法：以＂冠状动脉支架,生物相容性,炎症因子,细胞因子,血栓＂为关键词,采用计算机检索万方数据网1998-01/2010-12相关文章。纳入冠状动脉支架置入后炎症因子水平变化方面的文献,排除重复研究或Mata分析类文章。结果：冠状动脉内支架置入有可能会引起冠状动脉血管的损伤,促进体内细胞释放炎症因子,通过炎症因子和细胞因子的表达,能很好的反映支架置入后局部血管损伤程度和炎症水平。药物涂层支架能够显著降低支架置入后再狭窄发生率及靶病变再次血运重建率,但显著增加晚期支架血栓形成。通过凝血系统各因子水平评估,药物涂层支架置入前后充分地抗血小板治疗能够降低支架血栓的发生。结论：支架置入体内后与血液及血管壁接触可产生炎症和致敏反应,因此支架置入前后应充分控制炎症状态和抗凝血治疗。     

Major determinants for the uncovered stent struts on optical coherence tomography after drug-eluting stent implantation

There have been little data regarding major determinants for the uncovered stent struts after drug-eluting stent (DES) implantation on optical coherence tomography (OCT). We investigated the major determinants of incomplete neointimal coverage of DES struts on OCT after implantation in a large cohort of patients. A total of 261 patients with 279 lesions who were treated with various DESs were selected from the OCT registry database. The lesions were divided into two groups based on the ratio of uncovered struts to total struts in all OCT cross-sections; an uncovered group (highest quartile with % uncovered struts ≥5.4%, n?=?70), and covered group (the remaining lower quartiles with % uncovered struts <5.4%, n?=?209). The uncovered group was more likely to have complex lesions, smaller reference vessel and stent diameter, and longer stent, more use of sirolimus-eluting stents, and less use of zotarolimus-eluting stents compared with the covered group. Of these variables, the most significant determinant of uncovered stent struts was DES type (odds ratio [OR]?=?2.75, 95% confidence interval [CI]?=?1.94–3.89, P?<?0.001). The use of sirolimus-eluting stents (OR?=?2.44, 95% CI, 1.15–5.47, P?=?0.023) and zotarolimus-eluting stents (OR?=?0.02, 95% CI?=?0.01–0.25, P?=?0.002) were the only significant risk and protective factors for uncovered stent struts, respectively. This study demonstrated that DES type might be associated with the most important determinants of uncovered struts compared to any other clinical or angiographic factor.     

药物洗脱球囊在冠脉介入治疗后支架内再狭窄病变中的应用进展

经皮冠状动脉介入治疗(PCI)技术日趋成熟,已经在很大程度上提高了冠心病患者的生存率及生存质量。近10余年来,随着药物洗脱支架(DES)的普遍应用,介入治疗进入了新的阶段。然而,支架内再狭窄(ISR)的处理仍然是治疗的难点。药物洗脱球囊(DEB)能够将抗增生药物输送至靶病变部位,同时由于避免植入支架,减少了植入物刺激血管壁引起的炎症反应及内膜过度增生,从而降低了再狭窄率。因此,DEB在ISR等特殊病变治疗中具有特殊的优势。     

The average stent length is longer and the average stent diameter is shorter in patients with drug-eluting stents versus bare-metal stents during percutaneous coronary intervention

Drug-eluting stents (DES) were inserted in 180 patients (270 stents), mean age 63 years, and bare-metal stents (BMS) were inserted in 191 patients (301 stents), mean age 63 years, during percutaneous coronary intervention. Baseline characteristics were similar for patients treated with DES or BMS. The average stent length was longer for DES (16.83 mm) versus BMS (15.45 mm) (P = 0.0026). The average stent diameter was shorter for DES (2.89 mm) versus BMS (3.00 mm) (P = 0.00027). In-hospital stent thrombosis occurred in one of 270 DES (0.4%) versus three3 of 301 BMS (1.0%) (P = not significant).     

药物洗脱支架治疗急性心肌梗死的远期疗效观察

目的观察药物洗脱支架用于急性心肌梗死的安全性及远期临床疗效。方法97例发病3周以内的急性心肌梗死患者,其梗塞相关动脉行经皮冠状动脉介入治疗时使用药物洗脱支架(包括雷帕霉素及紫杉醇药物洗脱支架),并于术后(26.5±10.6)个月进行门诊及电话随访,必要时复查冠状动脉造影,观察住院及随访期间心血管事件发生率(死亡、再发急性心肌梗死及血管重建术)。结果125枚药物洗脱支架(雷帕霉素药物支架90枚,紫杉醇药物支架35枚)植入97个梗塞相关动脉,支架长度(24.4±6.1)mm,支架直径(3.0±0.4)mm;支架植入成功率100%。5例(5.2%)死亡,其中3例死于慢性心力衰竭,1例死于脑梗死,1例于术后1月死于可能的血栓形成;1例(1.0%)术后1周发生支架内急性血栓形成,而行靶血管再次血管重建术;1例因非靶血管病变致心绞痛于术后3月转外院行CABG术;无一例发生晚期支架内血栓形成及非致死性再梗。结论药物洗脱支架应用于急性心肌梗死治疗安全、有效,并可以明显降低再狭窄率,具有良好的远期效果。     

Anticipated impact of drug-eluting stents on referral patterns for coronary artery bypass graft surgery: a population-based angiographic analysis

OBJECTIVES: To determine the clinical and angiographic characteristics of patients who underwent coronary artery bypass graft (CABG) surgery before the availability of drug-eluting stents (DES) and to project the potential impact of percutaneous coronary intervention using DES. PATIENTS AND METHODS: We reviewed the coronary angiograms obtained between March 1999 and December 2001 of 192 consecutive patients from Olmsted County, Minnesota, who had undergone isolated CABG surgery for the first time. Three interventional cardiologists categorized the patients into 1 of 4 groups on the basis of technical feasibility of complete revascularization by percutaneous coronary intervention with DES. RESULTS: The study population consisted primarily of men (78%), with a mean age of 67 years. Of the 192 patients, 58 (30%) had diabetes mellitus, and 124 (65%) had 3-vessel disease. Twelve patients (6%) had lesions suitable for stents that matched the inclusion criteria for DES in recently published trials; 77 (40%) had lesions suitable for stents but had lesion characteristics not included in the initial DES trials. Thirty-two patients (17%) had target lesions considered technically difficult, but feasible, for stent placement. Seventy-one patients (37%) had lesions unsuitable for percutaneous coronary intervention (75% of these due to chronic occlusions) with the current stent delivery technology. CONCLUSION: This population-based analysis suggests that only a small proportion of patients undergoing CABG surgery meets the strict angiographic eligibility criteria for DES on the basis of recent trials. However, up to 46% of current CABG patients may ultimately undergo conversion to DES. The remaining 54% of this patient population may still not be ideal candidates for DES with the current stent delivery technology.     

紫杉醇药物洗脱支架置入后并发症:6个月随访

背景:紫杉醇药物洗脱支架临床应用的安全性和有效性已经国际临床试验研究证实,在适当放宽病变的入选标准情况下,其再狭窄发生率仍明显低于金属裸支架.目的:通过对应用紫杉醇药物洗脱支架的患者进行冠状动脉造影随访,观察该支架再狭窄发生情况和支架对局部血管的作用,探讨支架材料与宿主的生物相容性.设计:随访观察.单位:解放军总医院心内科.对象:选择2003-05/2005-05解放军总医院心血管内科有冠状动脉介入治疗指征,且行紫杉醇药物洗脱支架置入的冠心病患者297例,男265例,女32例,年龄36～76岁.患者均对治疗和实验知情同意;该实验经医院伦理委员会批准.方法:全部患者置入美国Boston Scientific生产的紫杉醇药物洗脱支架.患者支架术后6和12个月回院复查,并于术后6个月行冠状动脉造影,测量数据包括:靶血管参考管径、最小管腔直径,计算直径狭窄率、晚期管腔丢失情况.主要观察指标:紫杉醇药物洗脱支架置入后6个月冠状动脉造影结果,随访支架材料与宿主的生物相容性.结果:①冠状动脉造影定量分析结果:冠状动脉造影随访时,晚期管腔支架内丢失显著高于支架近端边缘及支架远端边缘,差异有显著性意义(P＜0.05).②支架再狭窄的随访:6个月时冠动脉造影有14例发生再狭窄,再狭窄发生率为10.4%(14/134).再狭窄的类型以支架内弥漫性再狭窄7例.再血管化率为6.7%.③支架动脉瘤形成:冠状动脉造影随访时显示支架部位有小动脉瘤形成1例,动脉瘤发生率为0.75%(1/134).④心血管不良事件:支架置入后1例4个月发生猝死,猝死发生率为0.34%(1/297).支架置入后5d发生支架内亚急性血栓形成1例,发生率0.34%(1/297).术后12个月晚期血栓形成2例,总心血管不良事件发生率为1.35%.结论:①紫杉醇药物洗脱支架的管腔丢失主要在支架内,置入后再狭窄以支架内弥漫性多见,心血管不良事件发生率较低.②紫杉醇药物洗脱支架可导致靶病变血管局部小的瘤样扩张.术后及随访结果总体数据显示紫杉醇药物洗脱支架与患者的生物相容性较好.     

Is stent thrombosis the new Achilles heel of interventional cardiology? State of the Art clinical trials, causes and approaches for prevention

Coronary stents are the mainstay of percutaneous coronary intervention. Stent thrombosis is a potentially catastrophic and often life-threatening complication. If it occurs it presents in up to 80% as myocardial infarction, about half of the affected patients die from this complication. The dual antiplatelet therapy has markedly reduced its occurrence. Today, stent thrombosis occurs in <1%, usually as a delayed event; but compared to bare metal stents the overall incidence has not increased in meta-analyses of randomized trials. The advent of drug-eluting stents (DES) has raised concerns regarding the occurrence of delayed stent thrombosis. Delayed arterial wall healing as well as prothrombotic characteristics of the drug eluting stent itself may contribute to stent thrombosis. In order to prevent stent thrombosis a standardized fixed dose antiplatelet therapy with ASA and clopidogrel is recommended. But, their efficacy depends on patient's individual characteristics such drug metabolism. Therefore, individual determination of platelet function in each patient undergoing stent implantation may help to avoid prothrombotic as well as bleeding complications.     

Early experiences and clinical implications of drug-eluting stents: part 1

OBJECTIVE: To review the pathogenesis of in-stent restenosis and the evolution of drug-eluting stents (DES). DATA SOURCES: Using the search terms sirolimus, paclitaxel, and drug-eluting stents, a literature review was conducted to identify peer-reviewed articles and abstracts in MEDLINE (1966-June 2003). Recent meeting abstracts were accessed through the American Heart Association and the American College of Cardiology Web sites. Citations from available articles were also reviewed for additional references. STUDY SELECTION AND DATA EXTRACTION: Published reviews and studies showing the effects of in-stent restenosis and drug-coated and -eluting stents were evaluated and reviewed. DATA SYNTHESIS: Coronary stent implantation is a common form of percutaneous coronary interventions. Approximately 20-30% of patients undergoing stent placement develop restenosis 6 months after the procedure. The primary cause of in-stent restenosis is neointimal proliferation and subsequent accumulation of extracellular matrix, collagen, and macrophages. Eluting stents with an antimitotic agent may reduce the extent of restenosis. Research is ongoing in terms of finding the ideal combination of antimitotic agent, stent, and eluting medium to create the perfect stent. CONCLUSIONS: Research over the last decade has led to a better understanding of the pathogenesis of in-stent restenosis and ways to prevent restenosis. DES are being developed as one of the strategies to prevent restenosis.     

Drug-eluting stents to prevent stent thrombosis and restenosis

Although first-generation drug-eluting stents (DES) have significantly reduced the risk of in-stent restenosis, they have also increased the long-term risk of stent thrombosis. This safety concern directly triggered the development of new generation DES, with innovations in stent platforms, polymers, and anti-proliferative drugs. Stent platform materials have evolved from stainless steel to cobalt or platinum–chromium alloys with an improved strut design. Drug-carrying polymers have become biocompatible or biodegradable and even polymer-free DES were introduced. New limus-family drugs (such as everolimus, zotarolimus or biolimus) were adopted to enhance stent performances. As a result, these new DES demonstrated superior vascular healing responses on intracoronary imaging studies and lower stent thrombotic events in actual patients. Recently, fully-bioresorbable stents (scaffolds) have been introduced, and expanding their applications. In this article, the important concepts and clinical results of new generation DES and bioresorbable scaffolds are described.     

Neoatherosclerosis assessed with optical coherence tomography in restenotic bare metal and first- and second-generation drug-eluting stents

Although reported in bare metal stents (BMS) and first-generation drug-eluting stents (DES), little is known about neoatherosclerosis in second-generation DES. We used optical coherence tomography to evaluate neoatherosclerosis among different stent generations. Overall, 274 in-stent restenosis (ISR) lesions (duration from implantation 56.9?±?47.2 months) in 274 patients were assessed for the presence of neoatherosclerosis. Neoatherosclerosis was identified in 38.7% of lesions (106/274): 23.0% second-generation DES (38/165), 65.1% first-generation DES (54/83), and 53.8% BMS (14/26). In the neoatherosclerosis cohort (n?=?106), more stent underexpansion or fracture/deformation was observed in second-generation DES, whereas thrombus, without plaque rupture, or evagination was more common in first-generation DES. In multivariable analyses, duration from implantation >1 year (OR: 2.44, 95% CI 1.12–5.31; p?=?0.03), absence of angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers (OR 1.95, 95% CI 1.10–3.44; p?=?0.02) or statins at the time of ISR (OR 3.12, 95% CI 1.42–6.84; p?=?0.01), and first-generation vs first-generation DES (OR 5.32, 95% CI 2.82–10.10; p?<?0.001) correlated with a higher prevalence of neoatherosclerosis. Duration from implantation <1 year (OR 2.17, 95% CI 1.03–4.55; p?=?0.04) and thin fibrous cap, thrombus, or rupture (OR 2.72, 95% CI 1.15–6.39; p?=?0.02) were independent predictors for acute coronary syndromes presentation. Neoatherosclerosis is an important ISR mechanism, especially in first generation DES.