Evaluating neoatherosclerosis for risk stratification of very-late DES failure

Drug-eluting stents (DESs) in comparison with bare metal stents (BMSs) have reduced early target lesion revascularization (TLR) through exerting an inhibitory effect on smooth muscle cell hyperplasia but have also increased the risk of stent thrombosis and TLR after 1 year, in other words, very-late stent failure (VLSF). Neoatherosclerosis or atherosclerosis progression is thought to be the major mechanism and is regarded as a ‘final common pathway of VLSF.’ Atherosclerosis can be detected by various intracoronary imaging modalities; e.g., angioscopy detects it as yellow plaque that has been regarded as vulnerable plaque and is associated with future event of acute coronary syndrome. Here, the findings of neoatherosclerosis using intracoronary imaging are reviewed and their relation with the long-term clinical outcome is discussed.