title: Lumen enlargement of the coronary segments located distal to chronic total occlusions successfully treated with drug-eluting stents at follow-up.
abstract: OBJECTIVE
  Chronic total occlusions (CTO) are the final stage of atherosclerosis. Occluded coronary arteries have large plaque burden and negative remodelling. The aim of this study was to assess lumen and vessel changes of segments located distal to successfully recanalised CTO.
  
  
  RESULTS
  Ninety-one CTO treated with drug-eluting stents underwent quantitative coronary angiography (QCA) at baseline and at 12-18 months; 31 underwent serial intravascular ultrasound (IVUS) imaging. Angiographic changes were assessed with QCA as differences in minimal, mean and maximal lumen diameter (MinLD, MeanLD and MaxLD, respectively). Vessel changes were assessed with IVUS as changes in plaque and vessel volume. At follow-up, angiographic MinLD increased 23.9% (from 0.88±0.32 to 1.09±0.35 mm; p<0.01), MeanLD 16.4% (from 1.59±0.44 to 1.85±0.45 mm; p<0.01) and MaxLD 11.7% (from 2.39±0.67 to 2.67±0.70 mm; p<0.01). Lumen enlargement was greater in non-restenotic lesions, small lumen area at the end of the index procedure and low LDL-cholesterol levels during the study. By IVUS, lumen volume increased 26.9% (from 108.1±89.2 to 137.3±115.3 mm3; p<0.01), vessel volume increased 12.1% (from 207.1±170.2 to 232.2±196.0 mm3; p<0.01) and plaque volume tended to decrease 3.9% (from 98.9±88.7 to 94.9±89.3 mm3; p=0.07). Small lumen at baseline was related to greater lumen enlargement.
  
  
  CONCLUSIONS
  Segments distal to recanalised CTO showed a notable lumen and vessel enlargement with a trend toward mild plaque regression. Low LDL-cholesterol levels increase lumen enlargement.
authors.affiliation: Department of Interventional Cardiology, Heart Disease Institute, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
authors.forename: Josep
authors.initials: J
authors.lastname: Gomez-Lara
authors.forename: Luis
authors.initials: L
authors.lastname: Teruel
authors.forename: Silvia
authors.initials: S
authors.lastname: Homs
authors.forename: José Luis
authors.initials: JL
authors.lastname: Ferreiro
authors.forename: Rafael
authors.initials: R
authors.lastname: Romaguera
authors.forename: Gerard
authors.initials: G
authors.lastname: Roura
authors.forename: Guillermo
authors.initials: G
authors.lastname: Sánchez-Elvira
authors.forename: Francesc
authors.initials: F
authors.lastname: Jara
authors.forename: Salvatore
authors.initials: S
authors.lastname: Brugaletta
authors.forename: Joan-Antoni
authors.initials: JA
authors.lastname: Gomez-Hospital
authors.forename: Angel
authors.initials: A
authors.lastname: Cequier
mesh_terms: D000368:Aged; D008078:Cholesterol, LDL / Q000097:blood; D002908:Chronic Disease; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000097:blood / Q000628:therapy*; D054059:Coronary Occlusion / Q000097:blood / Q000628:therapy*; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D054855:Drug-Eluting Stents; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention; D058226:Plaque, Atherosclerotic / Q000000981:diagnostic imaging; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
chemical_list: D008078:Cholesterol, LDL