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| Impact of Preinterventional Arterial Remodeling on In-Stent Neointimal Hyperplasia and In-Stent Restenosis After Coronary Stent Implantation : An Intravascular Ultrasound Study |
| The Heart Center of Chonnam National University Hospital, Chonnam National University Research Institute of Medical Science, Gwangju, Korea |
| Young Joon Hong, Myung Ho Jeong, Weon Kim, Sang Yup Lim, Sang Hyun Lee, Seo Na Hong, Kyung Ho Yun, Kye Hun Kim, Dong Goo Kang, Yeon Sang Lee, Ju Han Kim, Young Keun Ahn, Jeong Gwan Cho, Jong Chun Park, and Jung Chaee Kang |
Background: Patterns of adaptive arterial remodeling during the course of plaque development have been shown to play an important role in both the progression of de novo atherosclerosis and in the restenotic process following coronary interventions.
Objectives: The aim of this prospective study was to evaluate the effect of pre-interventional arterial remodeling on in-stent neointimal hyperplasia (NIH) and in-stent restenosis (ISR) after stent implantation.
Methods: Pre-interventional arterial remodeling was assessed in 85 native coronary lesions by using intravascular ultrasound (IVUS). Positive or intermediate remodeling (PR/IR) was defined as vessel area (VA) at the lesion site greater than or equal to that of average reference segment. Negative remodeling (NR) was defined as VA at the lesion site less than that of average reference segment. Remodeling index (RI) expressed as a continuous variable was defined as VA at the target lesion site divided by that of average reference segments.
Results: The RI was 1.09±0.20 in the PR/IR group and 0.84±0.12 in the NR group (p=0.001). The acute coronary syndrome was observed more frequently in the PR/IR group (88.5% vs. 57.6%, p=0.039). The multivessel disease was observed more frequently in the PR/IR group (17.3% vs. 0.0%, p=0.011). The plaque plus media cross sectional area (P&M CSA) and plaque burden in the minimal lumen CSA at pre-intervention were significantly larger in the PR/IR group (9.2±2.9mm2 vs. 6.2±1.8mm2, 73.6±8.3% vs. 65.8±7.8%, p=0.001, 0.032, respectively). The NIH CSA in the minimal lumen CSA at follow-up was significantly larger in the PR/IR group (3.3±1.2mm2 vs. 1.5±0.9mm2, p=0.001). A significant positive correlation was found between pre-interventional RI and pre-interventional P&M CSA, and follow-up NIH CSA (r=0.57, p<0.001, r=0.25, p=0.022). The incidence of ISR and repeat intervention was significantly higher in the PR/IR group (30.8% vs. 18.2%, 28.8% vs. 15.2%, p=0.032, 0.035, respectively).
Conclusion: Pre-interventional arterial remodeling influenced the development of NIH after stenting and measuring pre-interventional arterial remodeling patterns by IVUS may be helpful to stratify lesions at high-risk.
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