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Biomedical subjects

G S Mintz

Publications and source records attributed to G S Mintz.

At least 19 recordsLinked to original sources
PubMed1999

Procedural results and late clinical outcomes following multivessel coronary stenting.

OBJECTIVES: To evaluate in-hospital and long-term clinical outcomes in a large consecutive series of patients undergoing percutaneous multivessel stent intervention. BACKGROUND: High restenosis and recurrent angina rates have limited the clinical outcomes of multivessel coronary angioplasty before stents were available to improve angioplasty results. METHODS: We evaluated in-hospital and long-term clinical outcomes (death, Q-wave myocardial infarction [MI], and repeat revascularization rates at one year) in 398 consecutive patients treated with coronary stents in two (94% of patients) or three native arteries, compared to 1,941 patients undergoing stenting procedure in a single coronary artery between January 1, 1994 and August 29, 1997. RESULTS: Overall procedural success was obtained in 96% of patients with two- or three-vessel stenting and in 970% of patients with single-vessel stent intervention (p = 0.36). Procedural complications were also similar (3.8% for multivessel versus 2.9% for single vessel, p = 0.14). During follow up, target lesion revascularization was 15% in multivessel and 16% in single-vessel interventions (p = 0.38), and repeat revascularization (calculated per treated patient) was also similar for both groups (20% vs. 21%, p = 0.73). There was no difference in death (1.4% vs. 0.7%, p = 0.26), and Q-wave MI (1.2% vs. 0%, p = 0.02) was lower following multivessel interventions. Overall cardiac event-free survival was similar for both groups (p = 0.52). CONCLUSIONS: Unlike previous conventional angioplasty experiences, multivessel stenting has (1) similar in-hospital procedural success and major complication rates and (2) similar long-term (one year) clinical outcomes compared with single-vessel stenting. Thus, stents may be a viable therapeutic strategy in carefully selected patients with multivessel coronary disease.

Angioplasty, Balloon, Coronary↗
PubMed1998

A subgroup analysis of the Scripps Coronary Radiation to Inhibit Proliferation Poststenting Trial.

INTRODUCTION: In the Scripps Coronary Radiation to Inhibit Proliferation Poststenting (SCRIPPS) Trial, 192Ir significantly reduced angiographic, ultrasonographic, and clinical endpoints of restenosis. The objective of this analysis was to quantitate the impact of patient, lesion and technical characteristics on late angiographic outcome. METHODS: Patients with restenotic, stented coronary lesions were randomized to receive either 192Ir or placebo sources. Late luminal loss and loss index were calculated for several patient subgroups, including patients with diabetes, in-stent restenosis, multiple previous percutaneous transluminal coronary angioplasty (PTCA) procedures, longer lesion lengths, saphenous vein grafts, small vessel diameters, and minimum dose exposures < 8.00 Gy. Two-factor analysis of variance was used to test for an interaction between patient characteristics and treatment effect. RESULTS: In the treated group, late loss was particularly low in patients with diabetes (0.19 mm), in-stent restenosis (0.17 mm), reference vessel diameters < 3.0 mm (0.07 mm), and patients who received a minimum radiation dose to the entire adventitial border of at least 8.00 Gy. The loss index in each of these subgroups was similarly low at -0.02, 0.03, -0.02, and 0.03, respectively. By 2-factor analysis of variance, a significant interaction between subgroup characteristic and treatment effect (late loss) was found in patients with in-stent restenosis (p = 0.035), and patients receiving a minimum dose of 8.00 Gy to the adventitial border (p = 0.009). CONCLUSION: In this pilot study, patient characteristics associated with a more aggressive proliferative response to injury appeared to confer an enhanced response to radiotherapy. Furthermore, a dose threshold response to 192Ir was found with an enhanced response occurring when the entire circumference of the adventitial border was exposed to at least 8.00 Gy.

Analysis of Variance↗
PubMed1998

Intimal hyperplasia thickness at follow-up is independent of stent size: a serial intravascular ultrasound study.

The purpose of this study was to determine whether the thickness of the intimal hyperplasia (IH) layer that accumulates within Palmaz-Schatz stents is dependent on stent size. Intravascular ultrasound (IVUS) and quantitative angiographic (QCA) studies were performed after stent implantation and at follow-up (5.4 +/- 3.8 months) in 161 patients with 177 lesions treated with 221 Palmaz-Schatz stents. Stent and lumen cross-sectional area (CSA) were measured. IH CSA and thickness at follow-up were calculated and compared with stent CSA and circumference. Maximum IH CSA and thickness were measured at the smallest follow-up lumen CSA; mean IH CSA and thickness was averaged over the length of the stent. Maximum IH CSA measured 4.8 +/- 2.4 mm2, and mean IH CSA measured 2.8 +/- 2.2 mm2. Maximum IH thickness (at the smallest follow-up lumen CSA) measured 0.60 +/- 0.36 mm, and mean IH thickness (over the length of the stent) measured 0.30 +/- 0.19 mm. There was a weak, but significant correlation between mean and maximum IH CSA versus stent CSA (r = 0.215, p <0.0001 and r = 0.355, p <0.0001, respectively). However, there was no correlation between mean or maximum IH thickness versus stent CSA (r = 0.018, p = 0.643 and r = 0.056, p = 0.463, respectively) or stent circumference (r = 0.002, p = 0.956 and r = 0.069, p = 0.361, respectively). IH thickness was found to be independent of the stent size. This explains the known higher frequency of restenosis in smaller stents compared with larger stents.

Adult↗
PubMed1998

Intravascular ultrasound findings in stenting of unprotected left main coronary artery stenosis.

We evaluated the role of intravascular ultrasound (IVUS) in 16 patients with unprotected left main coronary artery (LMCA) stenting compared with 80 patients with other (non-LMCA) native coronary artery stenting and found that (1) additional high-pressure or larger size balloon dilations were more frequently performed in LMCA stenting than in non-LMCA stenting (p <0.05) and (2) after IVUS-guided stent implantation, minimum lumen area was > or = 9 mm2 in 88% of patients who underwent LMCA stenting and in 19% of those who underwent non-LMCA stenting (p <0.001). IVUS guidance may be a more important adjunctive imaging modality in the stenting of unprotected LMCA stenoses than in stenting of non-LMCA stenoses.

Aged↗
PubMed1998

Clinical, intravascular ultrasound, and quantitative angiographic determinants of the coronary flow reserve before and after percutaneous transluminal coronary angioplasty.

This study evaluated the clinical, intravascular ultrasound (IVUS), and angiographic determinants of the coronary flow reserve (CFR) as measured by guidewire Doppler velocimetry. Using standard methodology, 86 consecutive patients were studied before intervention (n = 73 patients, including the assessment of intermediate stenoses) and/or after intervention (n = 39 patients, including after percutaneous transluminal coronary angioplasty (PTCA) in 27 and post-Palmaz-Schatz stent placement + high-pressure adjunct PTCA in 12). Only 5 patients were studied before intervention, post-PTCA, and poststent. Univariate and multivariate clinical, quantitative coronary angiography (QCA), and IVUS correlates of the CFR were evaluated. There was a linear relation between CFR and IVUS minimum lumen cross-sectional area (CSA): r = 0.771, p <0.0001 for the overall cohort; r = 0.831, p <0.0001 before intervention; r = 0.514, p = 0.0061 post-PTCA; and r = 0.623, p = 0.0306 poststent placement. Overall, an IVUS minimum lumen CSA of > or = 4.0 mm2 had a diagnostic accuracy of 89% in identifying a CFR of > or = 2.0. This diagnostic accuracy increased slightly to 92% when only the preintervention observations were considered. Using multivariate linear regression analysis, the independent determinants of the CFR in the overall cohort of 112 observations were IVUS minimum lumen CSA (p <0.0001), angiographic lesion length (p = 0.0101), and diabetes mellitus (p = 0.0371): r2 = 0.6224. When the subset of preintervention observations were analyzed separately, the independent determinants of the CFR were minimum lumen CSA (p <0.0001) and angiographic lesion length (p = 0.0095); r2 = 0.7176. Thus, the major determinants of the CFR in patients with coronary artery disease are lumen compromise (which is best assessed by the IVUS measurement of the minimum lumen CSA) and lesion length. A minimum lumen CSA > or = 4.0 mm2 has a high diagnostic accuracy in predicting a CFR > or = 2.0, especially before intervention.

Aged↗
PubMed1998

Early lumen loss after treatment of in-stent restenosis: an intravascular ultrasound study.

BACKGROUND: Mechanisms of recurrence after treatment of in-stent restenosis are unknown. METHODS AND RESULTS: We prospectively performed quantitative coronary angiography (QCA) and intravascular ultrasound (IVUS) in 37 lesions with Palmaz-Schatz stents enrolled in a study of intracoronary radiation for in-stent restenosis. Primary treatment was at the discretion of the operator: PTCA (n=8) or ablation+adjunct PTCA (n=29). Lesions were studied before intervention, immediately after primary intervention, and 42+/-8 minutes later. QCA measurements included minimal luminal diameter and diameter stenosis. Planar IVUS measurements included arterial, stent, lumen, and in-stent tissue areas. Stent, lumen, and in-stent tissue volumes were calculated by use of Simpson's rule. Compared with immediately after intervention, the delayed (42+/-8 minutes) minimal lumen area decreased by 20% (5.8+/-1.9 to 4.5+/-1.3 mm2, P<0.0001) and the lumen volume by 12% (58+/-41 to 52+/-37 mm3, P=0.0001). Ten lesions (27%) had a > or = 2.0-mm2 decrease in minimum lumen area. Lumen loss (1) resulted from increased tissue with the stent, (2) correlated with lesion length and preintervention in-stent tissue, and (3) was not seen angiographically. CONCLUSIONS: There is significant tissue reintrusion shortly after catheter-based treatment of in-stent restenosis. This was greater in longer lesions and those with a larger in-stent tissue burden, was not reflected in the QCA measurements, and may contribute to recurrence.

Aged↗
PubMed1998

Impact of stents on clinical outcomes in percutaneous left main coronary artery revascularization.

Despite effective treatment of left main coronary artery (LMCA) disease by coronary bypass, there is still need for treatment of the LMCA due to progression of disease or bypass graft failure. We compared the in-hospital and follow-up (1-year) outcomes of patients with LMCA stenosis treated with stents (n = 88), with a matched group of patients undergoing LMCA non-stent procedures (n = 36). Ninety-seven percent of patients in each group underwent previous coronary bypass. Procedural success (angiographic success without major in-hospital complications) tended to be higher in stent patients than in their non-stent counterparts (98% vs 92%, p = 0.12), and overall procedural complications were higher for the non-stent group (5.4% vs 0%, p = 0.03). The incidence of non-Q-wave myocardial infarction was higher in patients with the LMCA treated with stents than in non-stent patients (13% vs 2.7%, p = 0.09). There was no difference in death or Q-wave myocardial infarction between the 2 groups during follow-up. Overall target lesion revascularization at 1 year was 15% after LMCA stenting, and 18% in non-stent patients (p = 0.71). Also, any cardiac event-free survival (including death, Q-wave myocardial infarction, coronary bypass, or angioplasty) was similar for both groups (78% for stents vs 76% for non-stents, p = 0.85). We conclude that in patients undergoing LMCA interventions, stents reduce major hospital complications, but may not significantly reduce repeat revascularization or major cardiac events at 1 year compared with non-stent LMCA procedures.

Aged↗
PubMed1998

Paradoxic decreases in atherosclerotic plaque mass in insulin-treated diabetic patients.

This study assessed the impact of diabetes mellitus on atherosclerotic lesion formation. Seventy insulin-treated diabetics, 150 non-insulin-treated diabetics, and 607 nondiabetics with chronic anginal syndromes and de novo native coronary stenoses were studied using (1) angiography, and (2) intravascular ultrasound (reference and lesion arterial, lumen, and plaque areas; area stenosis [reference-lesion/reference lumen area]; remodeling index [reference-lesion lumen area/lesion-reference plaque area]; and slope of the regression line relating lumen area to plaque burden [plaque/arterial area]). Despite being diabetic for longer and having similar lumen compromise, insulin-treated patients had (1) less reference plaque (8.3 +/- 3.4 vs 10.5 +/- 4.5 mm2, p = 0.0015), (2) less stenosis plaque (13.0 +/- 4.9 vs 16.9 mm2, p <0.0001), (3) smaller reference arterial areas (17.1 +/- 5.4 vs 19.7 +/- 6.2 mm2, p = 0.0063), and (4) smaller stenosis arterial areas (15.3 +/- 4.9 vs 19.5 +/- 6.5 mm2, p <0.0001) than non-insulin-treated diabetics. With use of multivariate linear regression analysis, insulin use was an independent (and negative) predictor of reference plaque and arterial areas (p = 0.0308 and p = 0.0179) and stenosis plaque and arterial areas (p = 0.0117 and p = 0.0066). This was also true when normalized for body surface area. The remodeling index showed that insulin treatment resulted in an exaggerated impact of plaque accumulation on lumen compromise. This was confirmed by the slope of the regression line relating lumen area to plaque burden. Patients with a longer duration of diabetes who were treated with insulin for > or = 1 year had (paradoxically) less reference segment and stenosis plaque accumulation. Possible explanations include impaired adaptive remodeling and/or arterial (and plaque) shrinkage.

Aged↗
PubMed1998

Procedural results and late clinical outcomes after placement of three or more stents in single coronary lesions.

BACKGROUND: Previous reports have suggested higher procedural and long-term complications among patients treated with multiple stents for diffuse lesions and/or long dissections. METHODS AND RESULTS: To evaluate procedural success, major complications, and clinical outcomes (> or = 1 year) in a consecutive series of patients treated with multiple (> or = 3) contiguous stents in single lesions, we evaluated in-hospital and long-term (1-year) clinical outcomes in 117 consecutive patients treated with > or = 3 coronary stents compared with a concurrent series of patients treated with 1 or 2 stents (n=1673) between January 1, 1994, and December 31, 1995. Multiple stents were implanted more often in larger vessels, in the right coronary artery or saphenous vein grafts, and for unfavorable lesion characteristics, including long (>20 mm), calcified, ulcerated, thrombotic, and/or flow-obstructing lesions. Overall procedural success was obtained in 97.4% of patients and was similar whether 1 or 2 versus > or = 3 stents were used. Non-Q-wave MI (CK-MB > or = 5 times normal) was more frequent after > or = 3 stents (22.8% versus 13.4%, P=.005). Target lesion revascularization (TLR) was 14.6% for 1 or 2 stents and 13.3% for > or = 3 stents (P=.70). There was no difference in death (2.2% versus 0.9%, P=.34) or Q-wave MI (1.4% versus 0.9%, P=.64) between the two groups (1 or 2 stents versus > or = 3 stents, respectively), and overall cardiac event-free survival was similar during follow-up (P=.70). CONCLUSIONS: Patients treated with multiple (> or = 3) contiguous stents compared with 1 or 2 stents have (1) similar in-hospital procedural success and major complications despite having more unfavorable lesion characteristics, (2) a higher rate of procedural non-Q-wave MI, and (3) similar TLR and overall major cardiac event rates during 1 year of follow-up.

Aged↗
PubMed1998

In-stent restenosis: the Washington Hospital Center experience.

In-stent restenosis has become a significant clinical problem. In 1997 alone, it is estimated that up to 100,000 patients world-wide with in-stent restenosis were treated. Serial intravascular ultrasound (IVUS) analysis has shown that tubular-slotted stents almost never chronically recoil and that neointimal hyperplasia is responsible for in-stent restenosis. With the rapid recent explosion in stent use, information about in-stent restenosis has lagged behind, especially on the impact of new stent designs. For example, the true prevalence of in-stent restenosis (1) varies with the lesion and patient subset, being much higher in the "real world" than in the selected patients typically enrolled in many studies; and (2) depends on its definition (i.e., clinical vs angiographic, intralesion vs in-stent). "Conventional" catheter-based treatments have included percutaneous transluminal coronary angioplasty (PTCA), rotational atherectomy, excimer laser coronary angioplasty, directional coronary atherectomy, and additional stent implantation. Rates of recurrence with these approaches are not known and vary considerably among series; however, certain lesions seem likely to recur regardless of the treatment modality. Recently, brachytherapy has emerged as the most promising way to treat in-stent restenosis.

Angioplasty, Balloon, Coronary↗
PubMed1998

Lipid-lowering therapy after coronary revascularization: the interventional cardiologist's perspective.

Despite the success of coronary interventions in the treatment of stenosis due to coronary atherosclerosis, it behooves cardiologists to treat the underlying disease by decreasing patients' cholesterol levels. Intravascular ultrasound has made it possible to detect plaque accumulation not visible on angiography. Although advanced lesions that are fibrous and calcific can be treated with atherectomy and lasers, it is the soft, lipid-laden plaque that is particularly vulnerable to rupture and leads to coronary events. Therefore, attention must also focus on decreasing atherosclerotic progression in patients who have undergone coronary interventions. Studies have clearly shown the value of cholesterol reduction in decreasing coronary events. However, a review of cardiologists' practices shows that more aggressive lipid-lowering therapy is needed. One way to achieve this goal is to treat and monitor patients who have undergone revascularization procedures and to encourage patients to become more involved in their own care.

Angioplasty, Balloon, Coronary↗
PubMed1998

Comparative early and nine-month results of rotational atherectomy, stents, and the combination of both for calcified lesions in large coronary arteries.

The aim of this study was to determine the preferred treatment modality for calcified lesions in large (> or = 3 mm) coronary arteries, resulting in the largest lumen dimensions and the most favorable late clinical responses. Three hundred six lesions in 306 patients (223 men, mean age 66 +/- 11 years) were treated with either rotational atherectomy plus adjunct balloon angioplasty (n = 147), Palmaz-Schatz stents (n = 103), or a combination of rotational atherectomy plus adjunct Palmaz-Schatz stents (n = 56). The procedural success rate was 98.0% to 98.6% for each treatment modality. Minimal lumen diameter (MLD) before therapy was similar for all therapies. Final MLD after combination of rotational atherectomy plus Palmaz-Schatz stents was larger than after stent therapy or rotational atherectomy plus balloon angioplasty (3.21 +/- 0.49 mm, 2.88 +/- 0.51 mm, and 2.29 +/- 0.55 mm, respectively, p <0.0001). Correspondingly, final percent diameter stenosis was lowest after the combination of rotational atherectomy plus stent therapy, and significantly higher for stents or rotational atherectomy plus balloon angioplasty (4.2 +/- 15.3%, 14.1 +/- 13.3%, and 26.7% +/- 16.9%, respectively, p <0.0001). Event-free survival at 9 months was higher for patients treated with the combination of rotational atherectomy plus stents than either stent therapy or rotational atherectomy alone (85%, 77%, and 67%, respectively, log-rank p = 0.0633). The only significant independent predictor of an event during the 9-month follow-up period was the MLD after intervention (odds ratio 0.495, 95% confidence interval 0.308 to 0.796, p = 0.0037). We conclude that preatheroablation using rotational atherectomy, followed by adjunct stent placement for calcified lesions in large arteries, is associated with infrequent complications, the largest acute angiographic results, and the most favorable late clinical event rates.

Aged↗
PubMed1998

Interrelation of coronary angiographic reference lumen size and intravascular ultrasound target lesion calcium.

Intravascular ultrasound (IVUS) detects target lesion calcium twice as often as does coronary angiography. Target lesions in smaller vessels are thought to be more calcified than target lesions in large vessels. This study determined whether the presence and magnitude of target lesion calcium is related to angiographic reference lumen size. Preintervention IVUS imaging and coronary angiography were performed to study 1,454 non-aortoostial native vessel lesions in 1,342 patients. Target lesions and reference segments were evaluated according to previously published methods and are presented as mean +/- 1 SD. By angiography, 37% of lesions contained calcium, and 68% of calcium-containing lesions were classified as moderately calcified, and 32% as severely calcified. There was no relation between angiographic reference lumen size and angiographic calcium detection (p = 0.7066) or classification (none/mild vs moderate vs severe, p = 0.8135). By IVUS, 73% of lesions contained calcium. There was a consistent relation between decreasing angiographic reference lumen size and increasing IVUS lesion-associated calcium: the presence of any calcium (p = 0.0122), arc of calcium (p = 0.002), percent of lesions with an arc of calcium > 180 degrees (p = 0.0018), length of calcium (p < 0.0001), presence of any superficial calcium (p < 0.0001), arc of superficial calcium (p < 0.0001), percent of lesions with an arc of superficial calcium > 180 degrees (p = 0.0021), and length of superficial calcium (p < 0.0001). This was especially true for arteries with an angiographic reference lumen dimension < 2.00 mm. There is a distinct relation between decreasing angiographic reference lumen size and increasing lesion calcium, most striking in vessels < 2.00 mm. This increased target lesion calcium in small vessels is not seen angiographically.

Aged↗
PubMed1998

'Optimal' directional coronary atherectomy: final results of the Optimal Atherectomy Restenosis Study (OARS).

BACKGROUND: Previous clinical trials of directional coronary atherectomy (DCA) have failed to show significant improvement in early or late outcomes compared with balloon angioplasty (PTCA). The present study tested the hypothesis that more aggressive "optimal" atherectomy could be performed safely to produce larger initial lumen diameters and a lower late restenosis rate. METHODS AND RESULTS: The present study was a prospective multicenter registry of consecutive patients undergoing optimal DCA of de novo or restenotic lesions in 3.0- to 4.5-mm native coronary arteries. Optimal DCA was defined as using a 7F atherectomy device and adjunctive PTCA if necessary to achieve a < 15% residual stenosis. Six-month angiographic and 1-year clinical follow-up was planned in all patients. A total of 199 patients with 213 lesions met eligibility criteria for enrollment. Short-term procedural success was achieved in 97.5%, with a major complication rate (death, emergency bypass surgery, or Q-wave myocardial infarction [MI]) of 2.5%. There were no early deaths. Non-Q-wave MI (CK-MB > 3 times normal) occurred in 14% of patients. Mean reference vessel diameter was 3.28 mm. Mean diameter stenosis was reduced from 63.5% to a final stenosis of 7%. Late 1-year clinical follow-up revealed one cardiac death and a target lesion revascularization rate of 17.8%. The angiographic restenosis rate at 6 months was 28.9%, with the major predictor of restenosis being a smaller postprocedure lumen diameter. CONCLUSIONS: Optimal DCA produced a low residual percent diameter stenosis and a lower restenosis rate than seen in previous trials without an increase in early or late major adverse events.

Aged↗
PubMed1998

Stenting of unprotected left main coronary artery stenoses: immediate and late outcomes.

OBJECTIVES: We examined the immediate and long-term outcomes after stenting of unprotected left main coronary artery (LMCA) stenoses in patients with normal left ventricular (LV) function. BACKGROUND: Left main coronary artery disease is regarded as an absolute contraindication for coronary angioplasty. Recently, several reports on protected or unprotected LMCA stenting, or both, suggested the possibility of percutaneous intervention for this prohibited area. METHODS: Forty-two consecutive patients with unprotected LMCA stenoses and normal LV function were treated with stents. The post-stent antithrombotic regimens were aspirin and ticlopidine; 14 patients also received warfarin. Patients were followed very closely with monthly telephone interviews and follow-up angiography at 6 months. RESULTS: The procedural success rate was 100%, with no episodes of subacute thrombosis regardless of anticoagulation regimen. Six-month follow-up angiography was performed in 32 of 34 eligible patients. Angiographic restenosis occurred in seven patients (22%, 95% confidence interval 7% to 37%); five patients subsequently underwent elective coronary artery bypass graft surgery (CABG), and two patients were treated with rotational atherectomy plus adjunct balloon angioplasty. The only death occurred 2 days after elective CABG for treatment of in-stent restenosis. The other patients (without angiographic follow-up) remain asymptomatic. CONCLUSIONS: Stenting of unprotected LMCA stenoses may be a safe and effective alternative to CABG in carefully selected patients with normal LV function. Further studies in larger patient populations are needed to assess late outcome.

Angioplasty, Balloon↗
PubMed1998

Intravascular ultrasound predictors of angiographic restenosis in lesions treated with Palmaz-Schatz stents.

OBJECTIVES: This study sought to evaluate the clinical, procedural, preinterventional and postinterventional quantitative coronary angiographic (QCA) and intravascular ultrasound (IVUS) predictors of restenosis after Palmaz-Schatz stent placement. BACKGROUND: Although Palmaz-Schatz stent placement reduces restenosis compared with balloon angioplasty, in-stent restenosis remains a major clinical problem. METHODS: QCA and IVUS studies were performed before and after intervention (after stent placement and high pressure adjunct balloon angioplasty) in 382 lesions in 291 patients treated with 476 Palmaz-Schatz stents for whom follow-up QCA data were available 5.5 +/- 4.8 months (mean +/- SD) later. Univariate and multivariate predictors of QCA restenosis (> or = 50% diameter stenosis at follow-up, follow-up percent diameter stenosis [DS] and follow-up minimal lumen diameter [MLD]) were determined. RESULTS: Three variables were the most consistent predictors of the follow-up angiographic findings: ostial lesion location, IVUS preinterventional lesion site plaque burden (plaque/total arterial area) and IVUS assessment of final lumen dimensions (whether final lumen area or final MLD). All three variables predicted both the primary (binary restenosis) and secondary (follow-up MLD and follow-up DS) end points. In addition, a number of variables predicted one or more but not all the end points: 1) restenosis (IVUS preinterventional lumen and arterial area); 2) follow-up DS (QCA lesion length); and 3) follow-up MLD (QCA lesion length and preinterventional MLD and DS and IVUS preinterventional lumen and arterial area). CONCLUSIONS: Ostial lesion location and IVUS preinterventional plaque burden and postinterventional lumen dimensions were the most consistent predictors of angiographic in-stent restenosis.

Adult↗
PubMed1998

Remodeling after directional coronary atherectomy (with and without adjunct percutaneous transluminal coronary angioplasty): a serial angiographic and intravascular ultrasound analysis from the Optimal Atherectomy Restenosis Study.

OBJECTIVES: The intravascular ultrasound (IVUS) substudy of OARS (Optimal Atherectomy Restenosis Study) was designed to assess the mechanisms of restenosis after directional coronary atherectomy (DCA). BACKGROUND: Recent serial IVUS studies have indicated that late lumen loss after interventional procedures was determined primarily by the direction and magnitude of arterial remodeling, not by cellular proliferation. METHODS: Complete quantitative coronary angiography (QCA) and IVUS were obtained in 104 patients before and after intervention and during follow-up. All studies were performed after administration of 200 microg of intracoronary nitroglycerin. Angiographic measurements included minimum lumen diameter (MLD), interpolated reference diameter and diameter stenosis (DS). Intravascular ultrasound measurements included lesion and reference external elastic membrane (EEM), lumen and plaque+media cross-sectional area (CSA). The axial location of the lesion site was at the smallest follow-up lumen CSA; the reference segment was the most normal-looking cross section within 10 mm proximal to the lesion but distal to any major side branch. Results are reported as mean +/- one standard deviation. RESULTS: The QCA reference decreased from 3.51 +/- 0.46 mm to 3.22 +/- 0.44 mm; the MLD decreased from 3.22 +/- 0.47 mm to 2.03 +/- 0.72 mm; and the DS increased from 8 +/- 10% to 38 +/- 20%. On IVUS, the decrease in lumen CSA (from 8.8 +/- 2.5 mm2 to 5.5 +/- 4.0 mm2) was associated with a significant decrease in EEM (from 19.7 +/- 5.6 mm2 to 16.9 +/- 6.2 mm2); there was no significant increase in P+M (from 10.9 +/- 4.2 mm2 to 11.3 +/- 3.9 mm2). A change in lumen correlated with a change in EEM (r = 0.790, p < 0.0001), not with a change in P+M (r = 0.133, p = 0.2258). A decrease in reference EEM (from 19.1 +/- 7.7 mm2 to 17.6 +/- 8.0 mm2) also correlated with a decrease in lesion EEM (r = 0.665, p < 0.0001). Results in restenotic lesions were similar. CONCLUSION: Restenosis after optimal DCA is caused primarily by a decrease in EEM CSA that extends into contiguous reference segments.

Anatomy, Cross-Sectional↗