Prediction of chronic vessel enlargement by a novel intravascular ultrasound finding.
BACKGROUND
Coronary arterial segments distal to the severely stenotic lesion sometimes shrink as a result of decreased coronary flow. Pathological studies have shown that vessel shrinkage is accompanied by folding of the internal elastic membrane (IEM). A peri-medial high-echoic band (PHB) by intravascular ultrasound (IVUS) may represent folding of the IEM and therefore detect chronically shrunken coronary segments that have potential to enlarge subsequently. METHODS AND RESULTS: IVUS imaging of the distal reference segments was performed in 27 patients after stenting. PHB was defined as a high-echoic band observed at the luminal side of the media. Serial (baseline and 9 months) changes in minimal lumen diameter (LD) were compared between those with (PHB group) and without PHB (non-PHB group). During follow-up, LD increased significantly in PHB group (1.2±0.3 vs. 1.7±0.5 mm, P=0.001) but not in the non-PHB group (2.0±0.7 vs. 2.1±0.7 mm, P=NS). Late lumen gain (LLG) was observed in 16 of the 27 (59%) lesions. Lesions with LLG showed a trend toward smaller baseline lumen cross-sectional area and significantly higher prevalence of PHB (88% vs. 18%, P=0.007). By multivariable logistic regression analysis, PHB was the only IVUS predictor of LLG.


CONCLUSIONS
Presence of PHB on IVUS predicts chronic enlargement of the coronary segments distal to the stented lesion.
Division of Cardiology, Kawasaki Medical School.
Yoji
Y
Neishi
Hiroyuki
H
Okura
Teruyoshi
T
Kume
Kenzo
K
Fukuhara
Ryotaro
R
Yamada
Kiyoshi
K
Yoshida
D000368:Aged; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000000981:diagnostic imaging* / Q000601:surgery; D054459:Elasticity Imaging Techniques / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention; D000091402:Prohibitins; D015607:Stents; D018084:Ultrasonography, Interventional / Q000379:methods