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Updated: May 6, 2026
Imaging In-Stent Restenosis: An Inexpensive, Reliable, and Rapid Preclinical Model
Published on: September 14, 2009
Impact of peri-stent remodeling on restenosis: a volumetric intravascular ultrasound study
M Nakamura1, P G Yock, H N Bonneau
1Center for Research in Cardiovascular Interventions, Stanford University, Stanford, California, USA.
Insights
Vessel remodeling after coronary stenting influences restenosis. Less outward vessel remodeling correlates with more in-stent hyperplasia and greater lumen loss.
Area of Science:
- Cardiovascular Research
- Interventional Cardiology
- Biomedical Engineering
Background:
- Vessel remodeling is a key factor in late lumen loss following coronary interventions without stenting.
- The specific role of vessel remodeling in in-stent restenosis remains under-investigated.
Purpose of the Study:
- To systematically investigate the impact of vessel remodeling on in-stent restenosis after coronary stenting.
- To quantify the relationship between peri-stent volume changes and intrastent neointimal hyperplasia.
Main Methods:
- Serial volumetric intravascular ultrasound analyses were performed in 55 lesions treated with balloon-expandable stents.
- Measurements included vessel volume, lumen volume, stent volume, peri-stent volume, and intrastent volume.
- Changes in these volumes were calculated and normalized as percent changes to assess remodeling and hyperplasia.
Main Results:
- Positive remodeling of the vessel exterior to the stent occurred variably.
- %Peri-stent volume (%PSV) strongly correlated with %Vessel Volume (%VV).
- A significant inverse correlation was observed between %PSV and the percent change in intrastent volume, indicating a trade-off.
Conclusions:
- Positive peri-stent remodeling is a significant factor after coronary stent implantation.
- Less peri-stent remodeling is associated with increased intrastent neointimal proliferation.
- This trade-off between remodeling and hyperplasia contributes to late lumen loss and in-stent restenosis.
Background:
Vessel remodeling is an important mechanism of late lumen loss after nonstent coronary interventions. However, its impact on in-stent restenosis has not been systematically investigated.
Methods And Results:
Serial volumetric intravascular ultrasound analyses (poststent and follow-up) were performed in 55 lesions treated with a balloon-expandable stent (ACS MultiLink) using standard stent deployment techniques. The vessel volume (VV), lumen volume (LV), and volume bordered by the stent (SV) were measured using Simpson's method. The volume of plaque and neointima outside the stent (peri-stent volume, PSV) and volume of neointima within the stent (intrastent volume) were also measured. The change of each parameter during the follow-up period (follow-up minus poststent) was calculated and then divided by SV to normalize these values (designated as percent change [%]). As expected, %PSV directly correlated with %VV (P<0.0001, r=0.935), with no significant SV. A highly significant inverse correlation was seen between %PSV and the percent change of intrastent volume (P<0.0001, r=0.517). Consequently, %LV significantly correlated with peri-stent remodeling, as measured by %VV (P<0.0001, r=0.602).
Conclusion:
Positive remodeling of the vessel exterior to a coronary stent occurs to a variable degree after stent implantation. There is a distinct trade-off between positive remodeling and in-stent hyperplasia: in segments in which the degree of peri-stent remodeling is less, intrastent neointimal proliferation is greater and accompanied by more significant late lumen loss.
