The recanalization of chronic total occlusion leads to lumen area increase in distal reference segments in selected patients: an intravascular ultrasound study.
OBJECTIVE
This study sought to investigate the extent of and factors related to lumen and vessel area change in coronary arteries after total occlusion (TO) recanalization.


BACKGROUND
TO of a coronary artery promotes negative remodeling in distal reference segments. Recanalization can restore blood flow, potentially leading to positive vascular remodeling.


METHODS
From March 2005 to June 2008, 58 consecutive patients with de novo TO lesions of at least 1-month duration were enrolled. We performed intravascular ultrasound after successful percutaneous coronary intervention and at the 6-month follow-up, and we quantified changes in the distal reference segments.


RESULTS
At the 6-month follow-up, there was a significant increase in the mean lumen diameter (+0.21 mm, p = 0.001), the mean external elastic membrane diameter (+0.13 mm, p = 0.010), the lumen area (+0.87 mm(2), p < 0.001), and the external elastic membrane area (+0.85 mm(2), p = 0.001) in the distal reference segments and an increase in the left ventricular ejection fraction (+2.77%, p = 0.010). Overall, 40 of 58 patients (69%) showed lumen area increase; these patients had increase in lumen diameter by 0.40 ± 0.34 mm (p < 0.001) and increase in incomplete stent apposition rate (p = 0.006). A TO duration of longer than 3 months (odds ratio [OR]: 14.8; 95% confidence interval [CI]: 1.28 to 172.8, p = 0.032), a poor collateral flow (OR: 12.0; 95% CI: 1.92 to 74.2, p = 0.008), and statin use (OR: 7.4; 95% CI: 1.03 to 53.6, p = 0.047) were independent predictors of lumen area increase.


CONCLUSIONS
Recanalization of TO led to lumen area increase in two-thirds of the patients. Independent predictors of lumen area increase were occlusion duration, a poor collateral flow, and statin use. These factors could be used as guides in choosing the optimal stent size during percutaneous coronary intervention to TO lesions and optimal medical therapy during follow-up.
Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea.
Jin Joo
JJ
Park
In-Ho
IH
Chae
Young-Seok
YS
Cho
Seong-Wook
SW
Kim
Han-Mo
HM
Yang
Jae-Bin
JB
Seo
Song-Yi
SY
Kim
Il-Young
IY
Oh
Chang-Hwan
CH
Yoon
Jung-Won
JW
Suh
Kyung-Woo
KW
Park
Woo-Young
WY
Chung
Tae-Jin
TJ
Youn
Dong-Ju
DJ
Choi
Hyo-Soo
HS
Kim
D023921:Coronary Stenosis / Q000000981:diagnostic imaging* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011446:Prospective Studies; D018084:Ultrasonography, Interventional