(Circulation. 1997;95:1791-1798.)
© 1997 American Heart Association, Inc.
Articles |
Contribution of Inadequate Arterial Remodeling to the Development of Focal Coronary Artery Stenoses
An Intravascular Ultrasound Study
From the Intravascular Ultrasound Imaging and Cardiac Catheterization Laboratories, The Washington Hospital Center, Washington, DC.
Correspondence to Martin B. Leon, MD, Director of Research, Washington Cardiology Center, Washington Hospital Center 4B-1, 110 Irving St, Washington, DC 20010.
Background Adaptive remodeling occurs to compensate for the accumulation of atherosclerotic plaque. Lumen reduction depends on the relative rates of plaque deposition and adaptive remodeling responses. Intravascular ultrasound permits detailed, high-quality, cross-sectional imaging of the coronary arteries in vivo.
Methods and Results Preintervention intravascular
ultrasound was used to study 603 focal, new, nonostial significant
coronary artery stenoses in patients with chronic stable angina.
Measurements of the target lesion of the external elastic membrane
(EEM), lumen, and plaque plus media (P&M; P&M=EEM-Lumen)
cross-sectional areas (CSAs) were compared with a proximal reference
segment (most normal-looking cross section within 10 mm proximal
to the lesion but distal to any side branch). Inadequate remodeling was
defined as lesion/reference EEM CSA that exceeded the upper limits of
normal arterial tapering (lesion/reference EEM CSA ratio 
0.78 or a
21% reduction in EEM CSA per 10-mm length). Overall, the
lesion/reference EEM CSA ratio was 1.00±0.22; 15% of lesions had
inadequate remodeling, and 37% of the 603 lesions had less plaque than
expected. This represented a lesion-specific response. The only
predictor of inadequate remodeling was the arc of superficial lesion
calcium.
Conclusions Inadequate remodeling is present in at least 15% of chronic, focal, new coronary arterial stenoses in patients with stable angina. The magnitude of arterial remodeling appears to be a lesion-specific response.
Key Words: ultrasonics • coronary disease • stenosis
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