Mechanism of lumen gain during coronary stent deployment in diabetic patients compared with non-diabetic patients
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Published on: May 14, 2013
Bonni Syeda1, Paul Wexberg, Mariann Gyongyosi
1Department of Internal Medicine II, University of Vienna, Austria. bonni.syeda@akh-wien.ac.at
Insights
Diabetic patients experience less lumen gain after coronary stenting due to plaque characteristics and vessel wall mechanics. This suggests alternative strategies may be needed for better outcomes in diabetic patients undergoing angioplasty.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Diabetes Mellitus Research
Background:
- Diabetic patients have a higher incidence of restenosis post-coronary angioplasty compared to non-diabetic individuals.
- Differences in lumen gain mechanisms during coronary revascularization may explain this disparity.
Purpose of the Study:
- To analyze the mechanism of lumen gain during coronary stent deployment in diabetic versus non-diabetic patients.
- To compare intravascular ultrasound (IVUS) parameters between these two groups.
Main Methods:
- Intravascular ultrasound (IVUS) imaging was performed before and after revascularization in 26 diabetic and 97 non-diabetic patients.
- External elastic membrane area (EEM), lumen area (LA), and plaque area (PA) were measured. Changes in these parameters (deltaEEM, deltaLA, deltaPA) were calculated.
- Differences in lesion length and inflation pressure were also assessed.
Main Results:
- Diabetic patients had larger pre- and post-interventional plaque areas (PA) and external elastic membrane areas (EEM).
- Post-interventional lumen area (LA), deltaEEM, and deltaLA were smaller in diabetic patients.
- Diabetic patients had longer lesion lengths and required higher inflation pressures during revascularization.
Conclusions:
- Diabetic patients exhibit reduced plaque area reduction and smaller post-interventional lumen areas after stenting, potentially due to vessel wall incompressibility.
- These findings suggest that alternative revascularization strategies, such as cutting balloon angioplasty or atherectomy prior to stenting, should be considered for diabetic patients to improve procedural outcomes.
Background:
Diabetic patients show an increased incidence of restenosis after coronary angioplasty than non-diabetic patients. This may be because of differences in the mechanism of lumen gain during coronary revascularization in this population cohort.
Design:
This study analyses the mechanism of lumen gain during coronary stent deployment in diabetic patients compared with non-diabetic patients with intravascular ultrasound (IVUS).
Methods:
IVUS images were obtained prior to and after revascularization in 26 diabetic and 97 non-diabetic patients. The external elastic membrane cross-sectional area (EEM) and lumen cross-sectional area (LA) were measured. Plaque area (PA) was calculated as EEM minus LA. Differences between pre- and post-LA (deltaLA), EEM (deltaEEM) and PA (deltaPA) were calculated.
Results:
Pre-interventional PA (diabetic patients: 12.4 +/- 4.4 mm2 compared with non-diabetic patients: 10.7 +/- 3.6 mm2, = 0.04) and pre-interventional EEM (15.5 +/- 4.4 mm2 compared with 13.6 +/- 3.7 mm2 respectively, P = 0.02) were larger in the diabetic group. Postinterventional PA (10.2 +/- 3.2 mm2 compared with 8.0 +/- 3.4 mm2, P = 0.004) was also larger and postinterventional LA (6.3 +/- 2.2 mm2 compared with 7.4 +/- 2.4 mm2 = 0.04), deltaEEM (0.9 +/- 1.8 mm2 compared with 1.8 +/- 1.8 mm2 P = 0.04) and deltaLA (3.1 +/- 1.6 mm2 compared with 4.2 +/- 2.2 mm2, P = 0.03) were smaller in the diabetic group. The diabetic group exhibited longer lesion lengths (P = 0.04) and a higher inflation pressure was used during revascularization in this patient cohort (P = 0.02).
Conclusion:
Diabetic patients have less reduction of PA during revascularization and because the vessel wall cannot be stretched outwards despite higher inflation pressure, postinterventional LA remains smaller than in the non-diabetic population cohort. This might be a rudiment for consideration of different treatment strategies such as cutting balloon or atherectomy prior to stenting in this population group in order to achieve better procedural outcome.
