Transcoronary Stem Cell Transfer and Evolution of Infarct-Related Artery Atherosclerosis: Evaluation with Conventional and Novel Imaging Techniques Including Quantitative Virtual Histology (Qvh)

Introduction: It has been suggested that infarct-related artery (IRA) atherosclerosis progression after stem cell transcoronary administration might represent a stem-cell mediated adverse effect.Aim: To evaluate, using conventional (quantitative coronary angiography, QCA, intravascular ultrasound -IVUS) and novel (quantitative virtual histology -qVH) tools, evolution of IRA atherosclerosis following transcoronary stem cell transfer.Material and methods: QCA, IVUS, VH-IVUS and qVH were performed in 22 consecutive patients (4 women) aged 59 years (data provided as median) undergoing a distal-to-stent infusion of 2.21 × 10 6 CD34 + CXCR4 + autologous bone marrow cells via a cell delivery-dedicated perfusion catheter at anterior AMI day 7. Imaging was repeated at 12 months.This was a substudy of Myocardial Regeneration by Intracoronary Infusion of Selected Population of Stem Cells in Acute Myocardial Infarction (REGENT) Trial (NCT00316381).Results: 18.2% subjects showed absence of distal-to-stent angiographic/IVUS atherosclerotic lesion(s) at baseline and no new lesion(s) at 12-months.In the remaining cohort, there were 28 lesions by QCA (32 by IVUS) at baseline and no new lesion(s) at follow-up.Three fibroatheromas evolved (2 to calcified fibroatheroma and 1 to a fibrocalcific lesion); other plaques maintained their stable (low-risk) phenotypes.Diameter stenosis of QCA-identified lesions was 29.5 vs. 26.5% (p = 0.012, baseline vs. 12-months).Gray-scale IVUS showed reduction in area stenosis (33.8 vs. 31.0%,p = 0.004) and plaque burden (66.27 vs. 64.56%,p = 0.009) at 12-months.Peak fibrotic plaque content increased from 70.41% to 75.0% (p = 0.004).qVH peak confluent necrotic core area and minimal fibrous cap thickness remained stable (0.64 vs. 0.59 mm 2 , p = 0.290, and 0.15 vs. 0.16 mm, p = 0.646).Conclusions: This study, using a range of classic and novel imaging techniques, indicates lack of any stimulatory effect of transcoronary stem cell transfer on coronary atherosclerosis.Whether, and to what extent, a moderate reduction in plaque burden and stenosis severity at 12-months results from optimized pharmacotherapy and/or stem cell transfer requires further elucidation.