title: Effects of radial stretch on target lesion revascularization after percutaneous coronary intervention: an intravascular ultrasound study.
abstract: OBJECTIVE
  To analyze possible associations between radial stretch during coronary angioplasty and the incidence of target lesion revascularization (TLR).
  
  
  METHODS
  Intravascular ultrasound images were obtained before and after revascularization in 182 native coronary lesions. The quantitative intravascular ultrasound parameters (external elastic membrane cross-sectional area [EEM-A], lumen areas [LA], plaque area [PA], calculated as EEM-A-LA, and changes between pre- and postinterventional LA [DLA], EEM-A [DEEM-A] and PA [DPA]) were correlated with the incidence of TLR.
  
  
  RESULTS
  TLR was performed in 60 (33%) patients, while 122 (67%) patients remained event free. Postinterventional PA remained significantly larger in the TLR group than in the event-free group (9.2 +/- 3.3 mm2 versus 7.9 +/- 3.3 mm2; P=0.02). The radial stretch during intervention, expressed as DEEM-A, and the balloon to artery ratio was significantly larger in the TLR group (DEEM-A: 1.9 +/- 2.1 mm2 versus 1.3 +/- 2.0 mm2; P=0.03; balloon to artery ratio: 1.3 +/- 0.2 versus 1.0 +/- 0.5; P=0.04). Multivariate analysis revealed DEEM-A (P=0.01), DPA (P=0.03), diabetes (P=0.001, odds ratio 5.2, 95% CI 4.9 to 6.5) and adaptive remodelling (P<0.001, odds ratio 4.1, 95% CI 3.5 to 6.4) as independent predictors for TLR.
  
  
  CONCLUSIONS
  Whereas patients in whom lumen gain is achieved primarily by plaque reduction with less wall stretch tend to remain event free, patients with significant radial stretch (ie, less reduction of the PA, but a radial outward shift of the plaque mass) experience a higher incidence of TLR.
authors.affiliation: Division of Cardiology, Department of Internal Medicine II, University of Vienna, Austria. bonni.syeda@akh-wien.ac.at
authors.forename: Bonni
authors.initials: B
authors.lastname: Syeda
authors.forename: Paul
authors.initials: P
authors.lastname: Wexberg
authors.forename: Mariann
authors.initials: M
authors.lastname: Gyongyosi
authors.forename: Stefan
authors.initials: S
authors.lastname: Denk
authors.forename: Gilbert
authors.initials: G
authors.lastname: Beran
authors.forename: Katharina
authors.initials: K
authors.lastname: Kiss
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Sperker
authors.forename: Dietmar
authors.initials: D
authors.lastname: Glogar
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D023903:Coronary Restenosis / Q000000981:diagnostic imaging / Q000601:surgery; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D009204:Myocardial Revascularization; D018084:Ultrasonography, Interventional