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CLINICAL RESEARCH: INTERVENTIONAL CARDIOLOGY

Arterial remodeling patterns before intervention predict diffuse in-stent restenosis

An intravascular ultrasound study

^* Department of Internal Medicine, the Cardiovascular Institute Hospital, Tokyo, Japan

Manuscript received March 19, 2003; revised manuscript received May 15, 2003, accepted May 20, 2003.

^* Reprint requests and correspondence: Dr. Makoto Sahara, Cardiovascular Institute Hospital, 7-3-10 Roppongi, Minato-Ku, Tokyo 106-0032, Japan.
cfo36210{at}par.odn.ne.jp

OBJECTIVES: The aim of this retrospective study was to determine the predictors of diffuse in-stent restenosis (ISR) among the lesions causing the first ISR by intravascular ultrasound (IVUS) studies.

BACKGROUND: Although some predictors of diffuse ISR have been reported, parameters on IVUS relating to diffuse ISR are not well characterized.

METHODS: We classified 52 ISR lesions that had undergone successful stent implantation and led to restenosis into two types—focal and diffuse ISR—using quantitative coronary angiography. Restenosis was defined as 50% diameter stenosis, and diffuse ISR as lesion length 10 mm at follow-up. The remodeling index (RI) was defined as the vessel area at the target lesion divided by that of averaged reference segments.

RESULTS: There were no significant differences in patient, angiographic, and procedural characteristics between the focal (n = 25) and diffuse (n = 27) ISR groups. Baseline RI was significantly greater in the diffuse ISR group (1.03 ± 0.18 vs. 0.88 ± 0.24, p = 0.0159). Negative remodeling, defined as RI <0.9, was detected in 60% of the focal ISR group and in only 26% of the diffuse ISR group. By logistic regression analysis, baseline RI was the only independent predictor of diffuse ISR (p = 0.0341). Moreover, volumetric analyses revealed that lesions developing into diffuse ISR had less capacity to compensate for further plaque growth.

CONCLUSIONS: Among the first ISR lesions, baseline positive remodeling was the most powerful predictor of diffuse ISR. Measuring pre-interventional arterial remodeling patterns by IVUS may be helpful to stratify lesions at higher risk.

Abbreviations and Acronyms   ISR = in-stent restenosis   IVUS = intravascular ultrasound   LV = lumen volume   PCI = percutaneous coronary intervention   PV = plaque volume   QCA = quantitative coronary angiography   RI = remodeling index   SV = stent volume   VA = vessel area   VV = vessel volume

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