Preintervention arterial remodeling affects clinical outcome following stenting: an intravascular ultrasound study.
OBJECTIVE
The study was done to elucidate the relationship between baseline arterial remodeling and clinical outcome following stenting.


BACKGROUND
The impact of preintervention arterial remodeling on subsequent vessel response and clinical outcome has been reported following nonstent coronary interventions. However, in stented segments, the impact of preintervention remodeling on clinical outcome has not been clarified.


METHODS
Preintervention remodeling was assessed in 108 native coronary lesions by using intravascular ultrasound (IVUS). Positive remodeling (PR) was defined as vessel area (VA) at the target lesion greater than that of average reference segments. Intermediate or negative remodeling (IR/NR) was defined as VA at the target lesion less than or equal to that of average reference segment. Remodeling index expressed as a continuous variable was defined as VA at the target lesion site divided by that of average reference segments.


RESULTS
Positive remodeling was present in 59 (55%) and IR/NR in 49 (45%) lesions. Although final minimal stent areas were similar (7.76 +/- 1.80 vs. 8.09 +/- 1.90 mm2, p = 0.36), target vessel revascularization (TVR) rate at nine-month follow-up was significantly higher in the PR group (22.0% vs. 4.1%, p = 0.01). By multivariate logistic regression analysis, higher remodeling index was the only independent predictor of TVR (p = 0.02).


CONCLUSIONS
Lesions with PR before intervention appear to have a worse clinical outcome following IVUS-guided stenting. Intravascular ultrasound imaging before stenting may be helpful to stratify lesions at high risk for accelerated intimal proliferation.
Center for Research in Cardiovascular Interventions, Stanford University Medical Center, California 94305-5637, USA.
H
H
Okura
Y
Y
Morino
A
A
Oshima
M
M
Hayase
M R
MR
Ward
J J
JJ
Popma
R E
RE
Kuntz
H N
HN
Bonneau
P G
PG
Yock
P J
PJ
Fitzgerald
D001158:Arteries / Q000000981:diagnostic imaging / Q000503:physiopathology; D017023:Coronary Angiography; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D015607:Stents; D018084:Ultrasonography, Interventional