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Development of neoatherosclerosis (NA) has been reported to be a potential cause of late stent failure. However, the distribution of NA and its relationship with neovascularization (NV) and adjacent plaque characteristics remain unclear.We investigated 167 stents (40 bare-metal stents, 84 sirolimus-eluting stents, and 43 everolimus-eluting stents) with optical coherence tomography. Each stent was divided into the proximal section (PS), mid section (MS) and distal section (DS). Neoatherosclerosis was defined as lipid-laden neointima or calcification inside stent. Adjacent plaque characteristics were evaluated within 5 mm proximal and distal reference segments.Neoatherosclerosis was more frequent in PS and DS than in MS (PS 19.8% vs MS 3.6% vs DS 21%: PS vs MS, P < .001: MS vs DS, P < .001). Neovascularization in PS and DS was also more prevalent compared with that in MS (PS 15% vs MS 5.4% vs DS 13.8%: PS vs MS, P = .001: MS vs DS, P = .001). Neoatherosclerosis was more frequently observed in stents with intraintima NV (68.6% vs 20.5%, P < .001). The incidence of NA was higher, when adjacent plaque was lipid (43.2% with lipid plaque vs 12.2% without lipid plaque, P < .001).Neoatherosclerosis occurs more frequently at PS and DS. Neoatherosclerosis was associated with NV and adjacent lipid plaque, suggesting potential interrelationship between development of NA and NV and adjacent plaque characteristics.