(Circulation. 1997;96:1470-1476.)
© 1997 American Heart Association, Inc.
Articles |
Highly Localized Arterial Remodeling in Patients With Coronary Atherosclerosis
An Intravascular Ultrasound Study
From the Division of Cardiology (H.L., T.N., M.C.F., N.L.E., S.W.T., R.J.S.), Cedars-Sinai Medical Center, Los Angeles, Calif, and the Department of Cardiology (H.B.), Huddinge University Hospital, Stockholm, Sweden.
Correspondence to Robert J. Siegel, MD, Division of Cardiology, Room 5335, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048.
Background Preservation of luminal area and symmetry in the presence of irregular plaques necessitates local expansion of the artery wall.
Methods and Results Cross-sectional dimensions of coronary arteries in 65 patients were measured with the use of intravascular ultrasound. A total of 104 arterial segments were studied, of which 88 had atherosclerosis; 16 served as nonatherosclerotic control segments. Three features of atherosclerotic arterial segments were classified: (1) plaque formation, (2) lumen shape, and (3) shape of arterial external elastic lamina. With our intravascular ultrasound–based three-level classification system, we identified three patterns that accounted for 89% of all atherosclerotic arterial segments: (1) concentric plaque with a circular lumen and a circular external elastic lamina (n=17), (2) eccentric plaque with a circular lumen and an oval external elastic lamina (n=35), and (3) eccentric plaque with an oval lumen and a circular external elastic lamina (n=26). A circular lumen was preserved in 66% of all atherosclerotic arterial segments. Arterial segments with a circular lumen in the presence of an eccentric plaque had a significantly larger lumen area than the other two main groups (P<.05).
Conclusions With our intravascular ultrasound–based classification, we provided information regarding the local remodeling response in the coronary artery wall. In a majority of cases, a circular lumen is maintained. Failure of this highly localized response to be operative may contribute to the development of stenotic lesions at a specific site in the artery.
Key Words: plaque • atherosclerosis • arteries • ultrasonics
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