Impact of preinterventional arterial remodeling on in-stent neointimal hyperplasia and in-stent restenosis after coronary stent implantation.
BACKGROUND
Patterns of arterial remodeling during the course of plaque development have been shown to play an important role in both the progression of de novo atherosclerosis and in the restenotic process following coronary intervention. The aim of the present prospective study was to evaluate the effect of pre-interventional arterial remodeling on in-stent neointimal hyperplasia (NIH) and in-stent restenosis (ISR) after stenting.


RESULTS
Pre-interventional arterial remodeling was assessed in 85 native coronary lesions by using intravascular ultrasound (IVUS). The remodeling index (RI) was 1.09+/-0.20 in the positive remodeling (PR)/intermediate remodeling (IR) group and 0.84+/-0.12 in the negative remodeling (NR) group. The plaque plus media cross sectional area (P&M CSA) at pre-intervention and NIH CSA at follow-up in the minimal lumen CSA were significantly larger in the PR/IR group (9.2+/-2.9 mm2 vs 6.2+/-1.8 mm2, 3.3+/-1.2 mm2 vs 1.5+/-0.9 mm2; p = 0.001, p = 0.001, respectively). On 3-dimensional analysis of IVUS images at follow-up, the lumen volume was significantly smaller in the PR/IR group than that in the NR group (62+/-15 mm3 vs 75 +/-20 mm3; p = 0.001), and neointima hyperplasia volume was significantly larger in the PR/IR group than that in the NR group (46+/-15 mm3 vs 26+/-10 mm3; p = 0.001). A significant positive correlation was found between pre-interventional RI and follow-up NIH CSA (r = 0.25, p = 0.022). The incidence of ISR and repeat intervention was significantly higher in the PR/IR group (30.8% vs 18.2%, 28.8% vs 15.2%; p = 0.032, 0.035, respectively).


CONCLUSIONS
Measuring pre-interventional arterial remodeling patterns by IVUS may be helpful to stratify lesions at high-risk of ISR.
Hong
Young Joon
YJ
The Heart Center of Chonnam National University Hospital, Chonnam National University Research Institute of Medical Sciences, Gwangju, Korea.
Jeong
Myung Ho
MH
Hyun
Dae Woo
DW
Hur
Seung Ho
SH
Kim
Kwon Bae
KB
Kim
Weon
W
Lim
Sang Yup
SY
Lee
Sang Hyun
SH
Hong
Seo Na
SN
Kim
Kye Hoon
KH
Yun
Kyung Ho
KH
Kang
Dong Goo
DG
Lee
Yun Sang
YS
Park
Hyung Wook
HW
Kim
Ju Han
JH
Ahn
Young Keun
YK
Cho
Jeong Gwan
JG
Park
Jong Chun
JC
Kang
Jung Chaee
JC
D000368:Aged; D001158:Arteries / Q000000981:diagnostic imaging / Q000473:pathology*; D001161:Arteriosclerosis / Q000473:pathology*; D023903:Coronary Restenosis / Q000209:etiology*; D005260:Female; D006801:Humans; D006965:Hyperplasia / Q000209:etiology*; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D012306:Risk; D015607:Stents / Q000009:adverse effects*; D017539:Tunica Intima / Q000473:pathology*; D018084:Ultrasonography, Interventional