Academic Journal
Histology-validated comparison of angioscopy, IVUS, and OFDI for assessing stent strut coverage in femoropopliteal arteries with thin neointima.
| Title: | Histology-validated comparison of angioscopy, IVUS, and OFDI for assessing stent strut coverage in femoropopliteal arteries with thin neointima. |
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| Authors: | Aihara K; Department of Cardiology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, 259-1193, Kanagawa, Japan., Torii S; Department of Cardiology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, 259-1193, Kanagawa, Japan. shoz3333@gmail.com., Nakamura N; Department of Cardiology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, 259-1193, Kanagawa, Japan., Hashimoto K; Department of Cardiology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, 259-1193, Kanagawa, Japan., Suzuki D; Department of Cardiology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, 259-1193, Kanagawa, Japan., Ohmura R; Department of Cardiology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, 259-1193, Kanagawa, Japan., Shiozaki M; Department of Cardiology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, 259-1193, Kanagawa, Japan., Sato Y; Department of Cardiology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, 259-1193, Kanagawa, Japan., Kato T; Department of Cardiology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, 259-1193, Kanagawa, Japan., Matsumoto Y; Department of Cardiology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, 259-1193, Kanagawa, Japan., Ikari Y; Department of Cardiology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, 259-1193, Kanagawa, Japan., Nakazawa G; Department of Cardiology, Kindai University, Sakai, Japan. |
| Source: | Cardiovascular intervention and therapeutics [Cardiovasc Interv Ther] 2026 Jul; Vol. 41 (3), pp. 680-689. Date of Electronic Publication: 2026 May 23. |
| Publication Type: | Journal Article; Comparative Study |
| Language: | English |
| Journal Info: | Publisher: Springer Country of Publication: Japan NLM ID: 101522043 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1868-4297 (Electronic) Linking ISSN: 18684297 NLM ISO Abbreviation: Cardiovasc Interv Ther Subsets: MEDLINE |
| Imprint Name(s): | Original Publication: Tokyo : Springer |
| MeSH Terms: | Angioscopy*/methods , Popliteal Artery*/diagnostic imaging , Popliteal Artery*/pathology , Popliteal Artery*/surgery , Femoral Artery*/diagnostic imaging , Femoral Artery*/pathology , Femoral Artery*/surgery , Ultrasonography, Interventional*/methods , Neointima*/pathology , Neointima*/diagnostic imaging , Stents*, Animals ; Swine |
| Abstract: | In-stent thrombotic occlusion remains a major clinical challenge after femoropopliteal stenting, and delayed healing is believed to contribute to this problem. However, conventional intravascular imaging may struggle to evaluate vascular healing due to limited resolution, particularly in thin neointima. This study aimed to validate the diagnostic performance of angioscopy for assessing endothelial strut coverage in thin neointima using histology as the reference standard. In a healthy swine model, 22 femoropopliteal arteries were evaluated one month after stenting. Ex vivo angioscopy, intravascular ultrasound (IVUS), and optical frequency domain imaging (OFDI) were performed. Endothelial strut coverage was assessed in segments with neointimal thickness < 1000 μm (thin neointima) using histology as the gold standard. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for detecting endothelial-covered struts were calculated. A total of 112 co-registered image sets were obtained, of which 62 were classified as thin neointima. Histology identified endothelial-covered struts in 8 of 62 segments (12.9%). Angioscopy color assessment showed a sensitivity of 100%, specificity of 92%, PPV of 60%, and NPV of 100%. In contrast, IVUS and OFDI demonstrated a high sensitivity for detecting endothelial-covered struts; however, overestimated coverage and failed to distinguish endothelial-covered struts from fibrin-covered struts (sensitivity 100%, specificity 0%, PPV 15%). While IVUS and OFDI overestimate endothelial stent coverage in thin neointima, angioscopy offers superior diagnostic accuracy for identifying fibrin-covered struts and may serve as a valuable modality for assessing vascular healing in femoropopliteal arteries, potentially facilitating the optimization of antithrombotic therapy. (© 2026. The Author(s).) |
| Competing Interests: | Declarations. Conflict of interest: Sho Torii received research grants from Abbot Vascular Japan, Boston Scientific Japan, and Medtronic, and received honoraria from Boston Scientific Japan. Gaku Nakazawa is a consultant for Boston Scientific, Abbott Vascular, Terumo Corp., and Japan Medical Device Technology Co., Ltd, and received research grants from Boston Scientific, Abbott Vascular, Terumo Corp., and Japan Medical Device Technology Co., Ltd. The remaining authors have nothing to disclose. Source of funding: None. |
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| Contributed Indexing: | Keywords: Angioscopy; Drug-Eluting stents; Endovascular therapy; Lower extremity artery disease; Pathology; Stent healing |
| Entry Date(s): | Date Created: 20260523 Date Completed: 20260618 Latest Revision: 20260813 |
| Update Code: | 20260813 |
| PubMed Central ID: | PMC13279681 |
| DOI: | 10.1007/s12928-026-01297-9 |
| PMID: | 42177329 |
| Database: | MEDLINE |
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