Angioscopic Findings after Drug-Eluting Stent Implantation

In-stent restenosis is the Achilles' heel of standard or bare-metal stent (BMS) implantation, occurring in 10-40% of the patients. Drug-eluting stent (DES) are supposed to inhibit inflammation and neointimal growth and, subsequently, in-stent restenosis. The neointimal proliferation inside the stent is recognized as lumen late loss on angiograms or as an obstruction area (or volume) on intravascular ultrasound (IVUS) in chronic phase. Coronary angioscopy provides direct visualization of the lumen and is capable of macroscopic pathologic diagnosis of atherosclerotic plaques and intracoronary thrombi. This modality is also able to supply detailed information on stent coverage with neointimal hyperplasia. The neointimal growth inside the stent is evaluated as white neointimal coverage over the stent struts. Angioscopic view inside the DES is quite different from that inside the BMS. In this article, the difference in angioscopic findings between the DES and the BMS is shown.