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CLINICAL STUDY: CARDIAC CATHETERIZATION AND INTERVENTION

Relationship between residual atheroma burden and neointimal growth in patients undergoing stenting

Analysis of the atherectomy before MULTI-LINK improves lumen gain and clinical outcomes trial intravascular ultrasound substudy

Ivan P. Casserly, MB BCh^*, Herbert D. Aronow, MDMPH^*, Paul Schoenhagen, MD^*, Hiroshi Tsutsui, MD^*, Jennifer Popovich, BA^*, Marlene Goormastic, MPH^*, Jeffrey J. Popma, MD, FACC, Steven E. Nissen, MD, FACC^* and E. Murat Tuzcu, MD, FACC^*,*

^* Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
Department of Cardiology, Brigham and Women’s Hospital, Boston, Massachusetts, USA

Manuscript received February 22, 2002; revised manuscript received June 4, 2002, accepted June 17, 2002.

^* Reprint requests and correspondence: Dr. E. Murat Tuzcu, Department of Cardiology, Desk F25, 9500 Euclid Ave, Cleveland, Ohio, USA 44195.
tuzcue{at}ccf.org

OBJECTIVES: The objective of this study was to examine the relationship between quantitative volumetric and cross-sectional measures of residual atheroma burden and neointimal growth after coronary stenting.

BACKGROUND: Previous intravascular ultrasound (IVUS) studies have demonstrated a correlation between residual atheroma burden and neointimal growth after coronary stenting. However, postmortem studies contradict this finding.

METHODS: The study population included 34 patients who underwent IVUS six to eight months after stent placement, including 26 patients who underwent IVUS immediately after stent placement and at six to eight months follow-up. Using manual planimetry, the lumen cross-sectional area (LA), stent cross-sectional area (SA) and external elastic membrane cross-sectional area (EEM) were measured at 1-mm intervals after the procedure and at follow-up. Percent neointimal area (NA) and atheroma area (AA) were calculated as: percent neointimal area = ([SA – LA]/SA) x 100; percent AA = ([EEM – SA]/EEM) x 100 in the entire cross section and in individual quadrants. Postinterventional atheroma volume and neointimal volume at follow-up were calculated using Simpsons’s rule.

RESULTS: In pooled analyses using all cross sections and cross-sectional quadrants, there was a weak correlation between percent AA and NA (r = 0.11 and 0.12, respectively). Analysis in individual patients demonstrated no significant relationship between total or quadrant measurements of percent AA and NA (p = 0.47 and 0.4, respectively). No relationship between atheroma volume postintervention and neointimal volume at follow-up was observed (r = 0.1, p = 0.62).

CONCLUSIONS: This study failed to demonstrate a clinically significant relationship between quantitative volumetric and cross-sectional measures of residual atheroma burden and subsequent neointimal growth.

Abbreviations and Acronyms   AA   atheroma area   AMIGO   Atherectomy Before MULTI-LINK Improves Lumen Gain and Clinical Outcomes trial   EEM   external elastic membrane cross-sectional area   IVUS   intravascular ultrasound   LA   lumen cross-sectional area   NA   neointimal area   SA   stent cross-sectional area

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