title: Preintervention arterial remodeling affects vessel stretch and plaque extrusion during coronary stent deployment as demonstrated by three-dimensional intravascular ultrasound.
abstract: The mechanisms of lumen enlargement during stent implantation may be significantly affected by arterial remodeling. To assess effects of lesion remodeling, we performed 3-dimensional intravascular ultrasound (IVUS) analyses in 55 coronary lesions before and after deployment of balloon-expandable stents. Standard quantitative analysis was performed, and arterial remodeling was assessed by the remodeling index (target site divided by mean of proximal and distal reference segment vessel areas), which classified lesions into group A (remodeling index < or =1, negative or intermediate remodeling, n = 40) or group B (remodeling index >1, positive remodeling, n = 15) lesions. Characteristics of the 55 patients and the interventional procedures were similar in the 2 groups. IVUS demonstrated that stenting resulted in increased lumen and vessel dimensions and in a reduced plaque size (p < or =0.001 each) in both group A and group B lesions. The extent of lumen increase inside the stents was almost identical, but resulted from different mechanisms: (1) vessel stretch was greater in group A (p <0.002 at minimum lumen site); (2) plaque compression (or embolization) tended to be greater in group B (p = 0.05, along entire stented segment); (3) plaque redistribution within the stent was observed in both groups (p <0.005 both); and (4) significant (p <0.01) plaque extrusion into the distal reference segment was found in group B only. Thus, the remodeling pattern of coronary lesions has a significant impact on the mechanisms of lumen enlargement during stent deployment. Lesions with positive remodeling show more plaque extrusion into the distal reference and less stent-induced vessel stretch than those with negative remodeling.
authors.affiliation: Department of Cardiology, Essen University, Essen, Germany. von.birgelen@freeler.nl
authors.forename: Clemens
authors.initials: C
authors.lastname: von Birgelen
authors.forename: Gary S
authors.initials: GS
authors.lastname: Mintz
authors.forename: Holger
authors.initials: H
authors.lastname: Eggebrecht
authors.forename: Jörg
authors.initials: J
authors.lastname: Herrmann
authors.forename: Matthias
authors.initials: M
authors.lastname: Jasper
authors.forename: Jens
authors.initials: J
authors.lastname: Brinkhoff
authors.forename: Till
authors.initials: T
authors.lastname: Neumann
authors.forename: Dirk
authors.initials: D
authors.lastname: Böse
authors.forename: Dietrich
authors.initials: D
authors.lastname: Baumgart
authors.forename: Axel
authors.initials: A
authors.lastname: Schmermund
authors.forename: Heinrich
authors.initials: H
authors.lastname: Wieneke
authors.forename: Michael
authors.initials: M
authors.lastname: Haude
authors.forename: Raimund
authors.initials: R
authors.lastname: Erbel
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D019917:Blood Vessel Prosthesis Implantation; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy*; D003331:Coronary Vessels / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery*; D004108:Dilatation, Pathologic / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy; D004548:Elasticity; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D015607:Stents; D017540:Tunica Media / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D018084:Ultrasonography, Interventional