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Evaluation of Four-Year Coronary Artery Response After Sirolimus-Eluting Stent Implantation Using Serial Quantitative Intravascular Ultrasound and Computer-Assisted Grayscale Value Analysis for Plaque Composition in Event-Free Patients

Jiro Aoki, MD^_*, Alexandre C. Abizaid, MD, PhD, FACC, Patrick W. Serruys, MD, PhD, FACC^_*,_*, Andrew T.L. Ong, MBBS, FRACP^_*, Eric Boersma, PhD^_*, J. Eduardo Sousa, MD, PhD, FACC and Nico Bruining, PhD^_*

^_* Erasmus Medical Center, Rotterdam, the Netherlands
Institute Dante Pazzanese of Cardiology, São Paulo, Brazil.

View larger version (106K): [in a new window]   Figure 1 (A) The adventitia is defined as tissue outside the external elastic membrane contour. For all non-shadowed adventitia pixels, the mean value and standard deviation are calculated. To observe the suitability, a normal distribution curve based on the same mean and standard deviation histogram is created. (B) Cross-sectional image of echogenicity and distribution graph of plaque echogenicity behind the stent struts. Hyperechogenic areas are colored green. Hypoechogenic areas are colored red. ROI = region of interest.

View larger version (18K): [in a new window]   Figure 2 (A) Correlation between neointimal volume and plaque volume behind the stent struts over four years. (B) Correlation between neointimal percent hypoechogenicity and plaque percent hypoechogenicity behind the stent struts over four years. Error bars indicate 95% confidence interval.

View larger version (90K): [in a new window]   Figure 3 A representative example of a patient with plaque compositional changes between two-year and four-year follow-up. Top row shows cross-sectional vessel image at (A) post-procedure, (B) four months, (C) one year, (D) two years, and (E) four years. Red line indicates lumen. Light blue line indicates stent. Green line indicates media. Dense blue line indicates adventitia. Bottom row shows cross-sectional echogenicity images. Hyperechogenic areas are colored green. Hypoechogenic areas are colored red. (A’) Percent plaque behind stent hypoechogenicity was 84.0% post-procedure, (B’) 85.3% at four months, (C’) 88.4% at one year, (D’) 84.2% at two years, and (E’) 74.8% at four years.