(Circulation. 1996;94:35-43.)
© 1996 American Heart Association, Inc.
Articles |
Arterial Remodeling After Coronary Angioplasty
A Serial Intravascular Ultrasound Study
From the Intravascular Ultrasound Imaging and Cardiac Catheterization Laboratories, the Washington Hospital Center, Washington, DC.
Correspondence to Martin B. Leon, MD, 110 Irving St NW (4B-1), Washington, DC 20010.
Background Restenosis occurs after 30% to 50% of transcatheter coronary procedures; however, the natural history and pathophysiology of restenosis are still incompletely understood.
Methods and Results Serial (postintervention and
follow-up) intravascular ultrasound imaging was used to study 212
native coronary lesions in 209 patients after
percutaneous transluminal coronary angioplasty,
directional coronary atherectomy, rotational atherectomy, or
excimer laser angioplasty. The external elastic membrane (EEM) and
lumen cross-sectional areas (CSA) were measured; plaque plus media
(P+M) CSA was calculated as EEM minus lumen CSA. The anatomic slice
selected for serial analysis had an axial location within the
target lesion at the smallest follow-up lumen CSA. At
follow-up, 73% of the decrease in lumen (from 6.6±2.5 to 4.0±3.7
mm2, P<.0001) was due to a decrease in
EEM (from 20.1±6.4 to 18.2±6.4 mm2,
P<.0001); 27% was due to an increase in P+M (from
13.5±5.5 to 14.2±5.4 mm2, P<.0001).
Lumen CSA correlated more strongly with EEM CSA
(r=.751, P<.0001) than with P+M CSA
(r=.284, P<.0001). EEM was bidirectional; 47
lesions (22%) showed an increase in EEM. Despite a greater increase in
P+M (1.5±2.5 versus 0.5±2.0 mm2,
P=.0009), lesions exhibiting an increase in EEM had (1) no
change in lumen (-0.1±3.3 versus 3.6±2.3
mm2, P<.0001), (2) a reduced
restenosis rate (26% versus 62%, P<.0001),
and (3) a 49% frequency of late lumen gain (versus 1%,
P<.0001) compared with lesions with no increase in EEM.
Conclusions Restenosis appears to be
determined primarily by the direction and magnitude of vessel wall
remodeling (EEM). An increase in EEM is adaptive, whereas a decrease
in EEM contributes to restenosis.
Key Words: angioplasty • restenosis • ultrasonics • remodeling
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