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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-

2005; Japanese Circulation Society; Volume: 69; Issue: 4 Linguagem: Inglês

10.1253/circj.69.414

1347-4820

Young Joon Hong, Myung Ho Jeong, Dae Woo Hyun, Seung‐Ho Hur, Kwon Bae Kim, Weon Kim, Sang Yup Lim, Sang Hyun Lee, Seo Na Hong, Kye Hoon Kim, Kyung Ho Yun, Dong Goo Kang, Yun Sang Lee, Hyung Wook Park, Ju Han Kim, Young Keun Ahn, Jeong Gwan Cho, Jong-Chun Park, Jung Chaee Kang,

Acute Myocardial Infarction Research

Background Patterns of 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 intervention. The aim of the present prospective study was to evaluate the effect of pre-interventional arterial remodeling on in-stent neointimal hyperplasia (NIH) and in-stent restenosis (ISR) after stenting. Methods and Results Pre-interventional arterial remodeling was assessed in 85 native coronary lesions by using intravascular ultrasound (IVUS). The remodeling index (RI) was 1.09±0.20 in the positive remodeling (PR)/intermediate remodeling (IR) group and 0.84±0.12 in the negative remodeling (NR) group. The plaque plus media cross sectional area (P&M CSA) at pre-intervention and NIH CSA at follow-up in the minimal lumen CSA were significantly larger in the PR/IR group (9.2±2.9 mm2 vs 6.2±1.8 mm2, 3.3±1.2 mm2 vs 1.5±0.9 mm2; p=0.001, p=0.001, respectively). On 3-dimensional analysis of IVUS images at follow-up, the lumen volume was significantly smaller in the PR/IR group than that in the NR group (62±15 mm3 vs 75 ±20 mm3; p=0.001), and neointima hyperplasia volume was significantly larger in the PR/IR group than that in the NR group (46±15 mm3 vs 26±10 mm3; p=0.001). A significant positive correlation was found between pre-interventional RI and follow-up NIH CSA (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 Measuring pre-interventional arterial remodeling patterns by IVUS may be helpful to stratify lesions at high-risk of ISR. (Circ J 2005; 69: 414 - 419)