Remodeling and Restenosis: Observations from Serial Intravascular Ultrasound Studies

Late responses to nonstent coronary interventions are determined less by intimal hyperplasia than by the direction and magnitude of arterial remodeling, except in diabetic patients. Negative arterial remodeling is a late event, is often preceded by an early (nonsustained) positive remodeling, and is distinct from passive elastic recoil. Diabetic patients have an exaggerated intimal hyperplastic response. Plaque burden may play an important role in the restenosis process by amplifying the negative remodeling. Stents reduce restenosis by opposing the late negative remodeling to offset a stent-related increase in neointimal hyperplasia. Both probucol and radiation appear to reduce late lumen loss after balloon angioplasty by promoting positive remodeling.