Progression of atheromatous plaque within neointima of coronary stents, which was termed neoatherosclerosis, has gained interest as a potential cause of very late stent failure. Pathologically, neoatherosclerosis was defined as the development of foamy macrophage clusters, fibroatheroma, thin-cap fibroatheroma, plaque rupture, and in-stent calcification within the stent. Following the pathological observations, a growing number of in vivo studies by using optical coherence tomography (OCT) and coronary angioscopy have been published to date. Those studies tried to clarify the features of neoatherosclerosis and have improved our knowledge substantially. Nevertheless, there still are missing information on natural history and clinical implications of neoatherosclerosis. The present review article summarized the definitions of neoatherosclerosis from the stands of view of pathology, OCT, and angioscopy. Moreover, what is known and what is not known regarding neoatherosclerosis were outlined for better understanding of pathophysiological consequences of coronary stents, which hopefully generates further ideas of clinical investigations.
Angioscopy is the only imaging modality that can directly evaluate the color of plaques. Therefore, nothing is more important to angioscopy than color. Plaque is classified into yellow plaque and white plaque according to their color. Yellow plaque has been considered to be vulnerable and high risk for the acute coronary syndromes, especially high-intense yellow plaque. Beta carotene is lipotorophic binding to lipid and coexisting with lipids in human atherosclerotic lesions and produces the yellow color of atherosclerotic plaque. Yellow plaque has several kinds of histopathology, such as a thin fibrous cap with lipid core, superficial or diffuse lipid deposition (cholesterol and cholesterol ester) with or without macrophage-foam cells and calcified plate. Therefore, all yellow plaques might not be vulnerable. Some pharmacological intervention and trans-catheter therapy decreased the intensity of yellow color. As angioscopic interpretation of color is usually subjective, objective computerized colorimetric evaluation is desirable.
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