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CLINICAL STUDY: INTERVENTIONAL CARDIOLOGY

Impact of pre-interventional arterial remodeling on subsequent vessel behavior after balloon angioplasty: a serial intravascular ultrasound study

^a Center for Research in Cardiovascular Interventions, Stanford University Medical Center, Stanford, California USA

Manuscript received March 7, 2001; revised manuscript received July 31, 2001, accepted August 27, 2001.

^* 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 USA
peter_fitzgerald{at}cvmed.stanford.edu

OBJECTIVES

The purpose of this study was to assess the impact of pre-intervention arterial remodeling on subsequent vessel behavior following balloon angioplasty.

BACKGROUND

Positive arterial remodeling before intervention has been shown to have a negative impact on the clinical outcome after nonstented coronary interventional procedures. However, the mechanism of interventions in coronary vessel geometry over time is less well characterized.

METHODS

Serial (pre-, post- and follow-up) intravascular ultrasound analysis was performed in 46 native coronary lesions. 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 was defined as VA at the target lesion site divided by that of average references.

RESULTS

Pre-interventional PR and IR/NR were present in 21 (46%) and 25 (54%) of 46 patients, respectively. At follow-up, the change in plaque area was similar between the two groups (1.3 ± 2.1 vs. 1.2 ± 2.1 mm², p = 0.840). Lesions with PR showed a significantly smaller change in VA than those with IR/NR (–0.2 ± 2.5 vs. 1.4 ± 2.3 mm², p = 0.03). As a result, late lumen loss was significantly larger in lesions whose pre-intervention configuration exhibited PR (–1.5 ± 1.8 vs. 0.2 ± 1.6 mm², p = 0.002).

CONCLUSIONS

Lesions with PR appear to have less capacity to compensate for further plaque growth after balloon angioplasty and thus show a proportional increase in late lumen loss. This may in part explain the less favorable clinical outcomes of positively remodeled lesions.

Abbreviations and Acronyms   DS = diameter stenosis   IR/NR = intermediate or negative remodeling   IVUS = intravascular ultrasound   LA = lumen area   PA = plaque area   PR = positive remodeling   VA = vessel area

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