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AngioscopicFindingsofNeointimalCoverageafterDrugElutingStentImplantation,ShinsukeNanto,M.D.,PhD.,DepartmentofAdvancedCardiovascularTherapeuticsOsakaUniversityGraduateSchoolofMedicine,.,Latethrombosisindrug-elutingcoronarystentsafterdiscontinuationofantiplatelettherapy,McFaddenEP,SerryusPWetal.Lancet2004,On442daysofDESimplantation,thepatientdevelopedAMIoneweekafteraspirinwasdiscontinuedbecauseofsurgicaltherapyofcoloncarcinoma.,Preprocedure,Stentimplantation,Postprocedure,Latestentthrombosis,FactorsofStentThrombosis,HondaYandFitzgeraldPJ.Circulation2003;108.,AngioscopicFindingsofNeointimalCoverageafterDrugElutingStentImplantation,CoronaryangioscplyVecmovaNEO(FiberTech,Tokyo,Japan),ClassificationofAngioscopicFindings,Grade0,Grade1,Grade2,Grade,Grade0:strutswereexposedsimilarlytothetimeofimplantationGrade1:strutswerecovered,butnotembeddedGrade2:strutswereembeddedbytheneo-intima,buttranslucencyseenGrade3:strutswerefullyembeddedandinvisiblebyangioscopy,KotaniJ,AwataM,NantoS,etal.JACC.2006,NeointimalCoverageGrades3to6MonthsAfterStentImplantation,Bare-MetalStent(n=22),(%),Incompletecoverage,Sirolimus-ElutingStent(n=15),Completecoverage,Grade3,Grade2,Grade1,Grade0,KotaniJ,AwataM,NantoS,etal.JACC.2006,RepresentativeCases:BMSvs.SES,Bare-metalstent(BMS)Sirolimus-elutingstent(SES)(Grade3)(Grade1),Stent:Cypher3.518mmLocation:RCAmid3.7monthsf-up,Stent:BxVelocity3.523mmLocation:LADmid2.7monthsf-up,ACaseimplantedbothBMSandDES,Followup3.7months,BxVerocity3.018,59y.o.female,Cypher3.518,12months,24months,months,ChangesinNeointimalCoverageGrade,AwataM,KotaniJ,NantoSetal.Circulation.2007,ComparisonofAngioscopicFindingsSESversusPESat8Months,ThirtyPESwereangioscopicallycomparedwith36SES.Intra-andinter-stentheterogeneintyofneointimalcoverageweremorecommoninPES.Incidenceofthrombiandyellowplaquesweresimilarbetweenthetwogroups.,AwataM,NantoSetal.JACCCardiolIntv2009,NeointimalCoverageGradesat8months,Grade0,Grade1,Grade2,Grade3,PESvs.SES:p=0.002by2testtest,(%),AwataM,NantoSetal.JACCCardiolIntv2009,Homogeneous,HeterogeneityofNeointimalCoverageGrades,AwataM,NantoSetal.JACCCardiolIntv2009,PESvs.SES:p=0.0006by2test,Heterogeneityof1grade,PES(n=30),SES(n=36),Heterogeneous,53%,47%,26%,48%,26%,Homogeneity,Heterogeneityof2grade,74%,ComparisonofAngioscopicFindingsSESversusZESat8Months,AwataM,NantoS,etal.JACC.2008,Cypher3.523mm,Endeavor3.523mm,NeointimalCoverageGradesat8months,In-stentateloss-SES=0.070.18mm-ZES=0.510.17mm（p0.0001）,IncidenceofThrombiandYellowplaques,(n=14),(n=16),P=0.2,(n=14),(n=16),P=0.004,Thrombi,Yellowplaques,AngioscopicFindingsZESvs.SES,8mo.afterimplantation,11mo.afterimplantation,.,ResultsofENDEAVOR-III,PatientFrequencyDistributionsofIn-segmentLateLoss,0.130.32,0.340.44,.,ResultsofENDEAVOR-III,PatientFrequencyDistributionsofIn-segmentLateLoss,0.130.32,0.340.44,.,TheIdealDESShouldHaveOptimalLateLosswithNarrowDistributions,0.130.32,0.340.44,IdealDES,Summary,AngiographicfindingsofDESrevealedProlongeddelayedgrowthofneointimaPoorbuthomogenouscoveringoverSESHeterogeneousluminalsurfaceofPESWhiteandhomogenousappearanceinpatientstreatedwithZES:Basicallygrade3neoinitmaAfewyellowplaquesandthrombi,TakeHomeMassagesNewConceptforNext-generationDES,Consideringtheriskofstentthrombosisduetoincompleteneointimalcoverage,itispr