title: Peri-stent reference segment plaque burden is associated with disease progression in saphenous vein grafts (a serial intravascular ultrasound assessment).
abstract: We are aware of no studies of peri-stent disease progression or luminal compromise in saphenous vein graft (SVG) lesions. We used serial intravascular ultrasound (IVUS) to assess disease progression in peri-stent saphenous vein bypass graft reference segments. We studied 37 peri-stent SVG reference segments in 21 patients; 16 were proximal and 21 were distal to the stent. The same anatomic image slice was analyzed after the intervention and at follow-up; this site was 3.68 +/- 2.22 mm from the stent edge. Graft age was 10.1 +/- 5.4 years, and mean follow-up duration was 13 months (range 3 to 61). Overall, change in SVG area, change in lumen area, and change in plaque burden correlated with postintervention plaque burden (r = 0.448, p = 0.005; r = -0.584, p <0.001; and r = 0.507, p = 0.001, respectively). For the proximal edge, change in lumen area correlated with change in plaque area (r = -0.951, p <0.001), but not with change in SVG area (r = -0.337, p = 0.201). For the distal edge, change in lumen area correlated more strongly with change in plaque area (r = -0.982, p <0.001) than with change in SVG area (r = -0.624, p = 0.003). When peri-stent reference segments were divided into 2 groups according to postintervention plaque burden (>50% [n = 20] vs <50% [n = 17]), there was a greater decrease in lumen area (-1.12 +/- 0.81 vs -0.33 +/- 0.26 mm(2), p <0.001) and greater increases in SVG area (0.26 +/- 0.29 vs 0.09 +/- 0.09 mm(2), p = 0.027), plaque area (1.37 +/- 0.96 vs 0.42 +/- 0.30 mm(2), p <0.001), and plaque burden (8.2 +/- 5.6% vs. 2.8 +/- 1.6%, p <0.001) in segments with a plaque burden >50%. In conclusion, peri-stent reference segment SVG disease progression and lumen loss were more significant in segments with a greater postintervention plaque burden after implantation of a bare metal stent or drug-eluting stent.
authors.affiliation: Cardiovascular Research Institute/Medstar Research Institute, Washington Hospital Center, Washington, DC, USA.
authors.forename: Young Joon
authors.initials: YJ
authors.lastname: Hong
authors.forename: Gary S
authors.initials: GS
authors.lastname: Mintz
authors.forename: Sang Wook
authors.initials: SW
authors.lastname: Kim
authors.forename: Teruo
authors.initials: T
authors.lastname: Okabe
authors.forename: Li
authors.initials: L
authors.lastname: Lu
authors.forename: Anh B
authors.initials: AB
authors.lastname: Bui
authors.forename: Augusto D
authors.initials: AD
authors.lastname: Pichard
authors.forename: Lowell F
authors.initials: LF
authors.lastname: Satler
authors.forename: Ron
authors.initials: R
authors.lastname: Waksman
authors.forename: Kenneth M
authors.initials: KM
authors.lastname: Kent
authors.forename: William O
authors.initials: WO
authors.lastname: Suddath
authors.forename: Neil J
authors.initials: NJ
authors.lastname: Weissman
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D004219:District of Columbia; D005260:Female; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D006801:Humans; D008297:Male; D008499:Medical Records; D012189:Retrospective Studies; D012501:Saphenous Vein / Q000637:transplantation*; D012720:Severity of Illness Index; D015607:Stents; D018084:Ultrasonography, Interventional