Abstract 3248: Is Pattern of Arterial Remodeling Contributing Factor on Suppression of Neointimal Hyperplasia After Stent Implanation in DES Era? An IVUS Study
Introduction : The pathomechanism of the bidirectional pattern of arterial remodeling is not yet completely understood, but it is considered that pre-interventional arterial remodeling play an important part in post-angioplastic restenosis after implantation of bare-metal stent. The aim of this study is to evaluate the effect of pre-interventional arterial remodeling on in-stent neointimal hyperplasia (NIH) after implantation of DES.
Method : The study population consisted of 85 patients(91 lesions) with de novo lesion treated with paclitaxel-eluting stent and evaluated by IVUS pre-, post-procedure and at 9 month follow-up.
Results : The remodeling index (RI) was 1.19±0.16 in the positive remodeling (PR)/intermediate remodeling (IR) group and 0.81±0.11 in the negative remodeling (NR) group. The external elastic membrane (EEM) CSA (18.7±5.4 vs 12.9±3.7 mm2, p=0.001), plaque plus media CSA (17.0±4.0 vs 10.3±3.5 mm2, p=0.001) and plaque burden (85.8±5.0 vs 81.8±7.3 %, p=0.048) at pre-intervention and NIH CSA (2.7±2.3 vs 0.8±1.3 mm2, p=0.001) at follow-up in the minimal lumen CSA were significantly larger in the PR/IR group compared to NR group. A significant positive correlation was found between pre-interventional RI and pre-interventional plaque plus media CSA (r=0.594, p=0.001) and follow-up NIH CSA (r=0.406, p=0.001). However, minimal lumen CSA (6.2±2.4 vs 6.2±2.1 mm2) at follow-up and the incidence of ISR (2/49 vs 3/42) were not different between both groups.
Conclusions : In DES era, pre-interventional arterial remodeling also influenced the development of NIH and pre-interventional RI correlated with the extent of pre-interventional plaque area and follow-up in-stent NIH. These findings may have potential implications for mechanical and pharmacokinetic properties of next generation DES technology.