Arterial remodeling and coronary artery disease: the concept of "dilated" versus "obstructive" coronary atherosclerosis
Paul Schoenhagen, MDa,
Khaled M. Ziada, MDa,
D. Geoffrey Vince, PhDa,
Steven E. Nissen, MD, FACCa and
E. Murat Tuzcu, MD, FACCa
a Cleveland Clinic Foundation, Cleveland, Ohio, USA
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Figure 1 Early plaque accumulation in human coronary arteries is associated with compensatory enlargement of vessel size (positive remodeling). Therefore, luminal size is initially not affected by plaque growth. These complex changes of lumen, plaque and external elastic membrane (EEM) may also affect plaque regression. Adapted from Glagov et al. (6). CAD = coronary artery disease.
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Figure 2 Positive and negative arterial remodeling describes extremes of the remodeling response. Longitudinal sections through vessel segments with positively and negatively remodeled lesions are shown. EEM = external elastic membrane; remodeling ratio (RR) = EEM area lesion/EEM area proximal reference.
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Figure 3 Intravascular ultrasound images show tomographic sections of the vessel, including lumen, vessel wall and adventitia. EEM = external elastic membrane.
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Figure 4 Example of negative remodeling. Intravascular ultrasound images of the proximal reference and lesion site are shown. The remodeling ratio is 0.71. EEM = external elastic membrane.
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Figure 5 Example of positive remodeling. Intravascular ultrasound images of the proximal reference and lesion site are shown. The remodeling ratio is 1.32. EEM = external elastic membrane.
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Figure 6 Static observation of arterial remodeling by comparing lesion and reference site. This figure shows longitudinal and cross-sectional sections through the lesion and reference. The external elastic membrane (EEM) area at the lesion site is larger than that at the reference site, defining positive remodeling.
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Figure 7 Serial observation of arterial remodeling. This figure shows longitudinal and cross-sectional sections through the same lesion at two different times. The lesion has progressed, characterized by an increased plaque and vessel size. The vessel expansion is defined as positive remodeling. EEM = external elastic membrane.
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Figure 8 Direction of remodeling and temporal development of plaques. Positive remodeling may be a characteristic of early, unstable lesions, allowing considerable plaque accumulation despite normal luminal size. Negative remodeling and fibrotic changes may be associated with more stable plaques. The observation of remodeling in relation to clinical presentation may be important in the assessment of plaque vulnerability and stabilization. EEM = external elastic membrane.
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Figure 9 Intravascular ultrasound images of a coronary aneurysm. A positive remodeled and a negative remodeled lesion are compared. Both vessel expansion and luminal obstruction can be manifestations of coronary artery disease.
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