Nagano Y, et al. - Researchers used an optical coherence tomography (OCT) registry to assess the significance of high-density lipoprotein (HDL) functionality for target-lesion revascularization in patients treated with coronary stents. For this purpose, they used a rapid cell-free assay system to assess the functional capacity of HDL to accept additional cholesterol (cholesterol-uptake capacity; CUC). The presence of neoatherosclerosis was assessed using OCT performed at a mean duration of 24.5 months post-stenting in 207 patients; 37 patients were found to have neoatherosclerosis, which was independently linked to decreased CUC in multivariate logistic regression analysis. A significant inverse association with incidence of target-lesion revascularization and with lipid accumulation inside stents was seen with CUC, suggesting that neoatherosclerosis contributes to the link between CUC and target-lesion revascularization. Decreased CUC indicated impaired HDL functionality, which might result in stent failure in the future by provoking atherogenic changes of the neointima within stents. An improved prediction of clinical outcomes following stent implantation might be achieved by evaluating HDL both quantitatively and qualitatively.