Advertisement

Effect of preintervention plaque burden on subsequent intimal hyperplasia in stented coronary artery lesions

      Abstract

      We sought to determine if axial and circumferential distribution of plaque before stenting determines the axial and circumferential distribution of subsequent intimal hyperplasia (IH). We studied 22 patients with a single Palmaz-Schatz stent implanted in a native coronary artery, who underwent intravascular ultrasound (IVUS) imaging before intervention, after stenting, and at 6-month follow-up. For each lesion, 7 locations were analyzed: proximal and distal reference, proximal and distal edge of the stent, proximal and distal location within the body of the stent, and the articulation. Pre- and postintervention and follow-up image slices were precisely aligned and analyzed for pre- and postintervention plaque area and follow-up IH area and thickness. The location of maximal IH area was at or adjacent to the location of maximal preintervention plaque in 17 of 22 of the patients (77%). Similiarly, the circumferential distribution of IH at follow-up paralleled the eccentricity pattern of the native plaque burden in 69% (24 of 35 slices). Using multivariant analysis, the strongest predictor of IH was preintervention plaque area (p = 0.001). IH accumulates axially and circumferentially preferentially at the site of maximal preintervention plaque.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Serruys P
        • De Jaegere P
        • Kiemeneij F
        • Macaya C
        • Rutsch W
        • Heyndrickx G
        • Emanuelsson H
        • Marco J
        • Legrand V
        • Benestent Study Group
        A comparison of balloon-expandable-stent implantation with balloon angioplasty in patients with coronary artery disease.
        N Engl J Med. 1994; 331: 489-495
        • Fischman D.L
        • Leon M.B
        • Baim D.S
        • Schatz R.A
        • Savage M.P
        • Penn I
        • Detre K
        • Veltri L
        • Ricci D
        • Nobuyoshi N
        • Stent Restenosis Study Investigators
        A randomized comparison of coronary-stent placement and balloon angioplasty in the treatment of coronary artery disease.
        N Engl J Med. 1994; 331: 496-501
        • Hoffmann R
        • Mintz G.S
        • Dussaillant G.R
        • Popma J.J
        • Pichard A.D
        • Satler L.F
        • Kent K.M
        • Griffin J
        • Leon M.B
        Patterns and mechanisms of in-stent restenosis. A serial intravascular ultrasound study.
        Circulation. 1996; 94: 1247-1254
        • Mudra H
        • Regar E
        • Klauss V
        • Werner F
        • Henneke K.-H
        • Sbarouni E
        • Theised K
        Serial follow-up after optimal ultrasound-guided deployment of Palmaz-Schatz stents. In-stent neointimal proliferation without significant reference segment response.
        Circulation. 1997; 95: 363-370
        • Aronson D
        • Bloomgarden Z
        • Rayfield E.J
        Potential mechanisms promoting restenosis in diabetic patients.
        J Am Coll Cardiol. 1996; 27: 528-535
        • Kastrati A
        • Schoemig A
        • Elezi S
        • Schuehlen H
        • Dirschinger J
        • Hadamitzky M
        • Wehinger A
        • Hausleiter J
        • Walter H
        • Neumann F.-J
        Predictive factors of restenosis after coronary stent placement.
        J Am Coll Cardiol. 1997; 30: 1428-1436
        • Hoffmann R
        • Mintz G.S
        • Mehran R
        • Pichard A.D
        • Kent K.M
        • Satler L.F
        • Popma J.J
        • Hongsheng W
        • Leon M.B
        Intravascular ultrasound predictors of angiographic restenosis in lesions treated with Palmaz-Schatz stents.
        J Am Coll Cardiol. 1998; 31: 43-49
        • Bauters C
        • Hubert E
        • Prat A
        • Bougrimi K
        • Van Belle E
        • McFadden E.P
        • Amouyel P
        • Lablanche J.M
        • Bertrand M
        Predictors of restenosis after coronary stent implantation.
        J Am Coll Cardiol. 1998; 31: 1291-1298
        • Nishimura R.A
        • Edwards W.D
        • Warnes C.A
        • Reeder G.S
        • Holmes Jr, D.R
        • Tajik A.J
        • Yock P.G
        Intravascular ultrasound imaging.
        J Am Coll Cardiol. 1990; 16: 145-154
        • Tobis J.M
        • Mallery J.A
        • Gessert J
        • Griffith J
        • Mahon D
        • Bessen M
        • Moriuchi M
        • McLeay L
        • McRae M
        • Henry W.L
        Intravascular ultrasound cross-sectional arterial imaging before and after balloon angioplasty in vitro.
        Circulation. 1989; 80: 873-882
        • Mintz G.S
        • Griffin J
        • Chuang Y.C
        • Pichard A.D
        • Kent K.M
        • Satler L.F
        • Popma J.J
        • Leon M.B
        Reproducibility of the intravascular ultrasound assessment of stent implantation in saphenous vein grafts.
        Am J Cardiol. 1995; 75: 1267-1270
        • Fuessl R.T
        • Mintz G.S
        • Pichard A.D
        • Kent K.M
        • Satler L.F
        • Popma J.J
        • Leon M.B
        In vivo validation of intravascular ultrasound length measurements using motorized transducer pullback system.
        Am J Cardiol. 1996; 77: 1115-1118
        • Mintz G.S
        • Popma J.J
        • Pichard A.D
        • Kent K.M
        • Satler L.F
        • Wong S.C
        • Hong M.K
        • Kovach J.A
        • Leon M.B
        Arterial remodeling after coronary angioplasty. A serial intravascular ultrasound study.
        Circulation. 1996; 94: 35-43
        • Hoffmann R
        • Mintz G.S
        • Popma J.J
        • Satler L.F
        • Pichard A.D
        • Kent K.M
        • Walsh C
        • Mackell P
        • Leon M.B
        Chronic arterial responses to stent implantation.
        J Am Coll Cardiol. 1996; 28: 1134-1139
        • Rasheed Q
        • Nair R
        • Sheehan H
        • Hodgson J.M
        Correlation of intracoronary ultrasound plaque characteristics in atherosclerotic coronary artery disease patients with clinical variables.
        Am J Cardiol. 1994; 73: 753-758
        • Mintz G.S
        • Popma J.J
        • Pichard A.D
        • Kent K.M
        • Satler L.F
        • Chuang Y.C
        • Ditrano C.J
        • Leon M.B
        Patterns of calcification in coronary artery disease. A statistical analysis of intravascular ultrasound and coronary angiography in 1155 lesions.
        Circulation. 1995; 91: 1959-1965
        • Prati F
        • Di Mario C
        • Moussa I
        • Reimers B
        • Mallus M.T
        • Parma A
        • Lioy E
        • Colombo A
        In-stent neointimal proliferation correlates with the amount of residual plaque burden outside the stent. An intravascular ultrasound study.
        Circulation. 1999; 99: 1011-1014
        • Karas S.P
        • Gravanis M.B
        • Santoian E.C
        • Robinson K.A
        • Anderberg K.A
        • King III, S.B
        Coronary intimal proliferation after balloon injury and stenting in swine.
        J Am Coll Cardiol. 1992; 20: 467-474
        • Flugelman M.Y
        • Virmani R
        • Correa R
        • Yu Z.X
        • Farb A
        • Leon M.B
        • Elami A
        • Fu Y.M
        • Casscells W
        • Epstein S.E
        Smooth muscle cell abundance and fibroblast growth factors in coronary lesions of patients with nonfatal unstable angina. A clue to the mechanism of transformation from the stable to the unstable clinical state.
        Circulation. 1993; 88: 2493-2500
        • Komatsu R
        • Ueda M
        • Naruko T
        • Kojima A
        • Becker A.E
        Neointimal tissue response at sites of coronary stenting in humans. Macroscopic, histologic, and immunohistochemical analysis.
        Circulation. 1998; 98: 224-233
        • Ferns G.A
        • Raines E.W
        • Sprugel K.H
        • Motani A.S
        • Reidy M.A
        • Ross R
        Inhibition of neointimal smooth muscle cell accumulation after angioplasty by an antibody to PDGF.
        Science. 1991; 253: 1129-1132
        • Jawien A
        • Bowen Pope D.F
        • Linder V
        • Schwartz S.M
        • Clowes A.W
        Platelet-derived growth factor promotes smooth muscle migration and intimal thickening in a rat model of balloon angioplasty.
        J Clin Invest. 1992; 89: 507-511
        • Schwartz R.S
        • Huber K.C
        • Murphy J.G
        • Edwards W.D
        • Camrud A.R
        • Vlietstra R.E
        • Holmes D.R
        Restenosis and the proportional neointimal response to coronary artery injury.
        J Am Coll Cardiol. 1992; 19: 267-274
        • Kornowski R
        • Hong M.K
        • Tio F.O
        • Bramwell O
        • Wu H
        • Leon M.B
        In-stent restenosis.
        J Am Coll Cardiol. 1998; 31: 224-230
        • Goldberg S.L
        • Di Mario C
        • Hall P
        • Colombo A
        Comparison of aggressive versus nonaggressive balloon dilatation for stent deployment on late loss and restenosis in native coronary arteries.
        Am J Cardiol. 1998; 81: 708-712
        • Dirschinger J
        • Kastrati A
        • Neumann F.J
        • Boekstegers P
        • Elezi S
        • Mehilli J
        • Schuhlen H
        • Pache J
        • Alt E
        • Blasini R
        • Steinbeck G
        • Schomig A
        Influence of balloon pressure during stent placement in native coronary arteries on early and late angiographic and clinical outcome.
        Circulation. 1999; 100: 918-923
        • Yang P
        • Gyongyosi M
        • Hassan A
        • Heyer G
        • Klein W
        • Luha O
        • Maurer E
        • Muhlberger V
        • Pachinger O
        • Sochor H
        • et al.
        Short- and long-term outcomes of Wiktor stent implantation at low versus high pressures. Austrian Wiktor Stent Study Group.
        Am J Cardiol. 1999; 84: 644-649
        • Hoffmann R
        • Mintz G.S
        • Papma J.J
        • Satler L.F
        • Kent K.M
        • Pichard A.D
        • Leon M.B
        Treatment of calcified coronary lesions with Palmaz-Schatz stents. An intravascular ultrasound study.
        Eur Heart J. 1998; 19: 1127-1129
        • Moussa I
        • Moses J
        • Di Mario C
        • Busi G
        • Reimers B
        • Kobayashi Y
        • Albiero R
        • Ferraro M
        • Colombo A
        Stenting after optimal lesion debulking (SOLD) registry. Angiographic and clinical outcome.
        Circulation. 1998; 98: 1604-1609