Effects of radial stretch on target lesion revascularization after percutaneous coronary intervention: an intravascular ultrasound study.
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.
Syeda
Bonni
B
Division of Cardiology, Department of Internal Medicine II, University of Vienna, Austria. bonni.syeda@akh-wien.ac.at
Wexberg
Paul
P
Gyongyosi
Mariann
M
Denk
Stefan
S
Beran
Gilbert
G
Kiss
Katharina
K
Sperker
Wolfgang
W
Glogar
Dietmar
D
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