Arterial remodeling patterns before intervention predict diffuse in-stent restenosis: an intravascular ultrasound study.

Makoto Sahara; Hajime Kirigaya; Yuji Oikawa; Junji Yajima; Ken Ogasawara; Hiroshi Satoh; Kazuyuki Nagashima; Hitoshi Hara; Yusuke Nakatsu; Tadanori Aizawa

doi:10.1016/j.jacc.2003.05.009

PubMed · 14642680

Arterial remodeling patterns before intervention predict diffuse in-stent restenosis: an intravascular ultrasound study.

Makoto Sahara·Hajime Kirigaya·Yuji Oikawa·Junji Yajima·Ken Ogasawara·Hiroshi Satoh·Kazuyuki Nagashima·Hitoshi Hara·Yusuke Nakatsu·Tadanori Aizawa

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Abstract

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 > or =50% diameter stenosis, and diffuse ISR as lesion length > or =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.

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Aged Angioplasty, Balloon, Coronary Arteries Coronary Artery Disease Coronary Restenosis Female Humans Male Middle Aged Predictive Value of Tests Retrospective Studies Stents Ultrasonography, Interventional Journal Article

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Makoto Sahara, Hajime Kirigaya, Yuji Oikawa, Junji Yajima, Ken Ogasawara, Hiroshi Satoh, Kazuyuki Nagashima, Hitoshi Hara, Yusuke Nakatsu, Tadanori Aizawa. 2003-11-19. Arterial remodeling patterns before intervention predict diffuse in-stent restenosis: an intravascular ultrasound study.. https://doi.org/10.1016/j.jacc.2003.05.009

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