Impact of attenuated-signal plaque observed by intravascular ultrasound on vessel response after drug-eluting stent implantation.
The aim of this study was to investigate the impact of attenuated-signal plaque (ASP) observed by intravascular ultrasound (IVUS) on vessel response after drug-eluting stent implantation.



Data were derived from the IVUS cohort of the J-DESsERT trial comparing paclitaxel- and sirolimus-eluting stents. Serial IVUS analysis (pre- and post-intervention, and 8-month follow-up) was performed in 136 non-AMI lesions. ASP was defined as hypoechoic plaque with ultrasound attenuation without calcification. Calcified plaque (CP) was defined as brightly echoreflective plaque with acoustic shadowing. ASP and CP scores were calculated by grading their measured angle as 0 to 4 for 0°, <90°, 90-180°, 180-270° and >270°, respectively. The entire stented segment was analyzed at 1-mm intervals.



At pre-intervention, ASP was observed in 40.4% of lesions, and this group had greater % neointimal volume (%NIV) at follow-up than the no-ASP group (p = 0.011). ASP score at pre-intervention positively correlated with %NIV (p = 0.023). During the follow-up, ASP score significantly decreased (p < 0.001), and CP score significantly increased (p < 0.001), with a negative correlation between them (p < 0.001). A decrease in the ASP score was associated with less %NIV in PES (p = 0.031), but not in SES (p = 0.229).



The greater extent of plaque with IVUS-signal attenuation at pre-intervention and its persistence during follow-up were associated with neointimal proliferation, possibly representing sustained inflammatory status, depending on the type of DES used.
Stanford University School of Medicine, Stanford, CA, USA.
Hideki
H
Kitahara
Stanford University School of Medicine, Stanford, CA, USA.
Katsuhisa
K
Waseda
Stanford University School of Medicine, Stanford, CA, USA.
Kenji
K
Sakamoto
Stanford University School of Medicine, Stanford, CA, USA.
Ryotaro
R
Yamada
Stanford University School of Medicine, Stanford, CA, USA.
Ching-Chang
CC
Huang
Stanford University School of Medicine, Stanford, CA, USA.
Daisaku
D
Nakatani
Stanford University School of Medicine, Stanford, CA, USA.
Kenji
K
Sakata
Stanford University School of Medicine, Stanford, CA, USA.
Osami
O
Kawarada
Stanford University School of Medicine, Stanford, CA, USA.
Paul G
PG
Yock
University of Tokyo, Tokyo, Japan.
Yutaka
Y
Matsuyama
Kokura Memorial Hospital, Kitakyushu, Japan.
Hiroyoshi
H
Yokoi
Toho University Ohashi Medical Center, Tokyo, Japan.
Masato
M
Nakamura
Saiseikai Yokohama-City Eastern Hospital, Yokohama, Japan.
Toshiya
T
Muramatsu
Osaka University, Suita, Japan.
Shinsuke
S
Nanto
Stanford University School of Medicine, Stanford, CA, USA.
Peter J
PJ
Fitzgerald
Stanford University School of Medicine, Stanford, CA, USA. Electronic address: crci-cvmed@stanford.edu.
Yasuhiro
Y
Honda
D000368:Aged; D002317:Cardiovascular Agents / Q000008:administration & dosage* / Q000009:adverse effects; D049109:Cell Proliferation / Q000187:drug effects; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000187:drug effects* / Q000473:pathology; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D007564:Japan; D008297:Male; D058426:Neointima; D017239:Paclitaxel / Q000008:administration & dosage* / Q000009:adverse effects; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation*; D058226:Plaque, Atherosclerotic; D011237:Predictive Value of Tests; D011446:Prospective Studies; D020123:Sirolimus / Q000008:administration & dosage* / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional; D061205:Vascular Calcification / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*
D002317:Cardiovascular Agents; D017239:Paclitaxel; D020123:Sirolimus
Attenuation; Drug-eluting stent; Intravascular ultrasound