Contribution of inadequate arterial remodeling to the development of focal coronary artery stenoses. An intravascular ultrasound study.
BACKGROUND
Adaptive remodeling occurs to compensate for the accumulation of atherosclerotic plaque. Lumen reduction depends on the relative rates of plaque deposition and adaptive remodeling responses. Intravascular ultrasound permits detailed, high-quality, cross-sectional imaging of the coronary arteries in vivo.


RESULTS
Preintervention intravascular ultrasound was used to study 603 focal, new, nonostial significant coronary artery stenoses in patients with chronic stable angina. Measurements of the target lesion of the external elastic membrane (EEM), lumen, and plaque plus media (P&M; P&M = EEM - Lumen) cross-sectional areas (CSAs) were compared with a proximal reference segment (most normal-looking cross section within 10 mm proximal to the lesion but distal to any side branch). Inadequate remodeling was defined as lesion/ reference EEM CSA that exceeded the upper limits of normal arterial tapering (lesion/reference EEM CSA ratio < or = 0.78 or a 21% reduction in EEM CSA per 10-mm length). Overall, the lesion/reference EEM CSA ratio was 1.00 +/- 0.22; 15% of lesions had inadequate remodeling, and 37% of the 603 lesions had less plaque than expected. This represented a lesion-specific response. The only predictor of inadequate remodeling was the arc of superficial lesion calcium.


CONCLUSIONS
Inadequate remodeling is present in at least 15% of chronic, focal, new coronary arterial stenoses in patients with stable angina. The magnitude of arterial remodeling appears to be a lesion-specific response.
Mintz
G S
GS
Intravascular Ultrasound Imaging and Cardiac Catheterization Laboratories, Washington Hospital Center, DC 20010, USA.
Kent
K M
KM
Pichard
A D
AD
Satler
L F
LF
Popma
J J
JJ
Leon
M B
MB
D000222:Adaptation, Physiological; D000368:Aged; D000787:Angina Pectoris / Q000209:etiology; D001161:Arteriosclerosis / Q000150:complications / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000503:physiopathology*; D002114:Calcinosis / Q000000981:diagnostic imaging / Q000209:etiology; D006328:Cardiac Catheterization; D002932:Cineangiography; D017023:Coronary Angiography; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D005996:Nitroglycerin / Q000008:administration & dosage; D012307:Risk Factors; D014463:Ultrasonography
D005996:Nitroglycerin