(Circulation. 2001;103:2130.)
© 2001 American Heart Association, Inc.
Brief Rapid Communication |
Impact of Peri-Stent Remodeling on Restenosis
A Volumetric Intravascular Ultrasound Study
From the Center for Research in Cardiovascular Interventions, Stanford University, Stanford, Calif (M.N., P.G.Y., K.K., P.J.F.,Y.H.); Highlands Consulting, Inc, San Jose, Calif (H.N.B.); Cardiovascular Institute, Tokyo, Japan (T.A.); and Shiga Medical Center for Adults, Moriyama, Japan (H.T.).
Correspondence to Paul G. Yock, MD, Center for Research in Cardiovascular Interventions, Stanford University Medical Center, 300 Pasteur Drive, Room H3554, Stanford, CA 94305-5637. E-mail pyock{at}cvmed.stanford.edu
Background—Vessel remodeling is an important mechanism of late lumen loss after nonstent coronary interventions. However, its impact on in-stent restenosis has not been systematically investigated.
Methods and
Results—Serial volumetric intravascular
ultrasound analyses (poststent and follow-up) were performed in
55 lesions treated with a balloon-expandable stent (ACS MultiLink)
using standard stent deployment techniques. The vessel volume (VV),
lumen volume (LV), and volume bordered by the stent (SV) were measured
using Simpson’s method. The volume of plaque and neointima
outside the stent (peri-stent volume, PSV) and volume of
neointima within the stent (intrastent volume) were also
measured. The change of each parameter during the follow-up
period (follow-up minus poststent) was calculated and then divided by
SV to normalize these values (designated as percent change [%
]).
As expected, %PSV directly correlated with %VV
(P<0.0001,
r=0.935), with no significant
SV. A highly significant inverse correlation was seen between
%PSV and the percent change of intrastent volume
(P<0.0001,
r=0.517). Consequently, %LV
significantly correlated with peri-stent remodeling, as measured by
%VV (P<0.0001,
r=0.602).
Conclusion—Positive remodeling of the vessel exterior to a coronary stent occurs to a variable degree after stent implantation. There is a distinct trade-off between positive remodeling and in-stent hyperplasia: in segments in which the degree of peri-stent remodeling is less, intrastent neointimal proliferation is greater and accompanied by more significant late lumen loss.
Key Words: coronary disease • plaque • remodeling • stents • restenosis
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