HOME SUBSCRIPTIONS CURRENT ISSUE PAST ISSUES CARDIOSOURCE SEARCH HELP FEEDBACK		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Okura, H. Articles by Fitzgerald, P. J. Search for Related Content PubMed PubMed Citation Articles by Okura, H. Articles by Fitzgerald, P. J.

CLINICAL STUDY: INTERVENTIONAL CARDIOLOGY

Preintervention arterial remodeling affects clinical outcome following stenting: an intravascular ultrasound study

Hiroyuki Okura, MD^*, Yoshihiro Morino, MD^*, Akio Oshima, MD^*, Motoya Hayase, MD^*, Michael R. Ward, MD, PhD^*, Jeffrey J. Popma, MD, Richard E. Kuntz, MD, MSc, Heidi N. Bonneau, RN, MS^*, Paul G. Yock, MD^* and Peter J. Fitzgerald, MD, PhD^*

^* Center for Research in Cardiovascular Interventions, Stanford University Medical Center, Stanford, California, USA
Brigham and Women’s Hospital, Boston, Massachusetts, USA

Manuscript received April 12, 2000; revised manuscript received October 30, 2000, accepted December 6, 2000.

Reprint requests and correspondence: Dr. Peter J. Fitzgerald, Center for Research in Cardiovascular Interventions, Stanford University Medical Center, 300 Pasteur Drive, H3554, Stanford, California 94305-5637
peter_fitzgerald{at}cvmed.stanford.edu

OBJECTIVES

The study was done to elucidate the relationship between baseline arterial remodeling and clinical outcome following stenting.

BACKGROUND

The impact of preintervention arterial remodeling on subsequent vessel response and clinical outcome has been reported following nonstent coronary interventions. However, in stented segments, the impact of preintervention remodeling on clinical outcome has not been clarified.

METHODS

Preintervention remodeling was assessed in 108 native coronary lesions by using intravascular ultrasound (IVUS). Positive remodeling (PR) was defined as vessel area (VA) at the target lesion greater than that of average reference segments. Intermediate or negative remodeling (IR/NR) was defined as VA at the target lesion less than or equal to that of average reference segment. Remodeling index expressed as a continuous variable was defined as VA at the target lesion site divided by that of average reference segments.

RESULTS

Positive remodeling was present in 59 (55%) and IR/NR in 49 (45%) lesions. Although final minimal stent areas were similar (7.76 ± 1.80 vs. 8.09 ± 1.90 mm², p = 0.36), target vessel revascularization (TVR) rate at nine-month follow-up was significantly higher in the PR group (22.0% vs. 4.1%, p = 0.01). By multivariate logistic regression analysis, higher remodeling index was the only independent predictor of TVR (p = 0.02).

CONCLUSIONS

Lesions with PR before intervention appear to have a worse clinical outcome following IVUS-guided stenting. Intravascular ultrasound imaging before stenting may be helpful to stratify lesions at high risk for accelerated intimal proliferation.

Abbreviations and Acronyms   CRUISE = Can Routine Ultrasound Influence Stent Expansion study   IR/NR = intermediate or negative remodeling   IVUS = intravascular ultrasound   LA = lumen area   MLD = minimal lumen diameter   PA = plaque area   PR = positive remodeling   SD = standard deviation   TVR = target vessel revascularization   VA = vessel area

This article has been cited by other articles:

				H. Okura, H. Taguchi, T. Kubo, I. Toda, M. Yoshiyama, J. Yoshikawa, and K. Yoshida Impact of arterial remodelling and plaque rupture on target and non-target lesion revascularisation after stent implantation in patients with acute coronary syndrome: an intravascular ultrasound study Heart, October 1, 2007; 93(10): 1219 - 1225. [Abstract] [Full Text] [PDF]

				C. von Birgelen, M. Hartmann, G. S. Mintz, D. Bose, H. Eggebrecht, T. Neumann, M. Gossl, H. Wieneke, A. Schmermund, M. G. Stoel, et al. Remodeling Index Compared to Actual Vascular Remodeling in Atherosclerotic Left Main Coronary Arteries as Assessed With Long-Term (>=12 Months) Serial Intravascular Ultrasound J. Am. Coll. Cardiol., April 4, 2006; 47(7): 1363 - 1368. [Abstract] [Full Text] [PDF]

				M. Sahara, H. Kirigaya, Y. Oikawa, J. Yajima, K. Ogasawara, H. Satoh, K. Nagashima, H. Hara, Y. Nakatsu, and T. Aizawa Arterial remodeling patterns before intervention predict diffuse in-stent restenosis: An intravascular ultrasound study J. Am. Coll. Cardiol., November 19, 2003; 42(10): 1731 - 1738. [Abstract] [Full Text] [PDF]

				G. S. Mintz, A. Tinana, M.-K. Hong, C. W. Lee, J.-J. Kim, N. E. Fearnot, S.-W. Park, S.-J. Park, and N. J. Weissman Impact of Preinterventional Arterial Remodeling on Neointimal Hyperplasia After Implantation of (Non-Polymer-Encapsulated) Paclitaxel-Coated Stents: A Serial Volumetric Intravascular Ultrasound Analysis From the ASian Paclitaxel-Eluting Stent Clinical Trial (ASPECT) Circulation, September 16, 2003; 108(11): 1295 - 1298. [Abstract] [Full Text] [PDF]

				V. Spanos, G. Stankovic, J. Tobis, and A. Colombo The challenge of in-stent restenosis: insights from intravascular ultrasound Eur. Heart J., January 2, 2003; 24(2): 138 - 150. [Full Text] [PDF]

				T. Kataoka, E. Grube, Y. Honda, Y. Morino, S.-H. Hur, H. N. Bonneau, A. Colombo, C. Di Mario, G. Guagliumi, K. E. Hauptmann, et al. 7-Hexanoyltaxol-Eluting Stent for Prevention of Neointimal Growth: An Intravascular Ultrasound Analysis From the Study to COmpare REstenosis rate between QueST and QuaDS-QP2 (SCORE) Circulation, October 1, 2002; 106(14): 1788 - 1793. [Abstract] [Full Text] [PDF]

				H. Okura, M. Hayase, S. Shimodozono, H. N. Bonneau, P. G. Yock, and P. J. Fitzgerald Impact of pre-interventional arterial remodeling on subsequent vessel behavior after balloon angioplasty: a serial intravascular ultrasound study J. Am. Coll. Cardiol., December 1, 2001; 38(7): 2001 - 2005. [Abstract] [Full Text] [PDF]