title: Soft plaque detected on intravascular ultrasound is the strongest predictor of in-stent restenosis: an intravascular ultrasound study.
abstract: OBJECTIVE
  Although various predictors of in-stent restenosis (ISR) have been reported, the subject of parameters relating to ISR on intravascular ultrasound (IVUS) still leaves room for discussion. The aim of this study was to clarify the strongest predictors of ISR using IVUS.
  
  
  RESULTS
  Ninety-two native coronary lesions undergoing single bare-metallic stent implantation were investigated retrospectively. We classified them into the ISR (n=46) and non-ISR (n=46) groups using quantitative coronary angiography. On serial IVUS studies, plaque morphology, and areas and volumes of each component in vessel were evaluated. Among all parameters, diabetes mellitus and soft plaque appearing hypoechoic on IVUS were associated with ISR. By multivariate analysis, soft plaque was the only independent predictor of ISR (p=0.0057). Compared with non-soft plaque, soft plaque had a larger plaque reduction rate (-7.1% vs. -1.6%, p=0.0613) and smaller percent plaque volume (53.0% vs. 55.5%, p=0.0273) after stenting. Conversely, soft plaque had a larger neointimal area (4.39 vs. 3.33 mm2, p=0.0437) and percent plaque area (80.5% vs. 75.1%, p=0.0503) at follow-up.
  
  
  CONCLUSIONS
  Soft plaque detected on IVUS was the strongest predictor of ISR. Soft plaque was compressed more easily by stenting, however, causing more proliferation of neointima subsequently and resulted in a worse prognosis.
authors.affiliation: Department of Internal Medicine, The Cardiovascular Institute Hospital, 7-3-10 Roppongi, Minato-Ku, Tokyo 106-0032, Japan. cfo36210@par.odn.ne.jp
authors.forename: Makoto
authors.initials: M
authors.lastname: Sahara
authors.forename: Hajime
authors.initials: H
authors.lastname: Kirigaya
authors.forename: Yuji
authors.initials: Y
authors.lastname: Oikawa
authors.forename: Junji
authors.initials: J
authors.lastname: Yajima
authors.forename: Kazuyuki
authors.initials: K
authors.lastname: Nagashima
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Hara
authors.forename: Ken
authors.initials: K
authors.lastname: Ogasawara
authors.forename: Tadanori
authors.initials: T
authors.lastname: Aizawa
mesh_terms: D000368:Aged; D023903:Coronary Restenosis / Q000000981:diagnostic imaging* / Q000473:pathology / Q000628:therapy; D019160:Endosonography; D005260:Female; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D011379:Prognosis; D012189:Retrospective Studies; D015607:Stents