Neoatherosclerosis after drug-eluting stent implantation: A novel clinical and therapeutic challenge

Filippo Crea, Rocco Vergallo, Italo Porto, Antonio Bisignani, Mattia Galli, Gianmarco Annibali, Rocco Antonio Montone, Antonio Maria Leone, Giampaolo Niccoli, Josip A. Borovac

Research output: Contribution to journalArticle

16 Citations (Scopus)


The recognition that obstructive disease of the epicardial coronary arteries, causing ischaemic heart disease, can be treated with a percutaneous coronary intervention (PCI) has been a major discovery in cardiology in the last 40 years contributing, in particular, to the reduction of mortality associated to acute myocardial infarction (AMI). However, even in the era of drug-eluting stent (DES) implantation, a sizable proportion of patients who undergo PCI may develop late or very late post-implantation complications, that occur in the form of restenosis, neoatherosclerosis, and/or in-stent thrombosis. Such complications are clinically relevant since they can cause AMI and negatively impact on the outcome. The underlying pathophysiological mechanisms are complex but related to inhibition of neointimal proliferation by DES that, on the hand, reduces the rate of in-stent restenosis, but, on the other hand, causes dysfunctional vessel healing, persistent inflammation, platelet activation, and adverse immunological responses. Multiple approaches have been developed or are under evaluation to target DES-related complications including pharmacotherapy, procedure-related imaging methods, novel stent designs, and drug-delivery methods. The aim of this review is to provide an update on the latest preclinical, translational, and clinical pharmacotherapeutic developments in this setting that target novel cellular mechanisms and pathways that might contribute to neoatherosclerosis. Due to the importance of secondary prevention in the reduction of DES-associated complications, this review also provides a short overview of pharmacological agents that are established or currently being investigated in this regard.
Original languageEnglish
Pages (from-to)105-116
Number of pages12
Publication statusPublished - 2019


  • Animals
  • Coronary Artery Disease
  • Coronary Restenosis
  • Coronary Thrombosis
  • Coronary Vessels
  • Coronary restenosis
  • Coronary thrombosis
  • Drug-Eluting Stents
  • Drug-eluting stents
  • Humans
  • Neoatherosclerosis
  • Neointima
  • Percutaneous Coronary Intervention
  • Percutaneous coronary intervention
  • Pharmacotherapy
  • Plaque, Atherosclerotic
  • Prosthesis Design
  • Risk Factors
  • Secondary Prevention
  • Treatment Outcome


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