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Arterial remodeling patterns before intervention predict diffuse in-stent restenosis: an intravascular ultrasound
Makoto Sahara1, Hajime Kirigaya, Yuji Oikawa
1Department of Internal Medicine, the Cardiovascular Institute Hospital, Tokyo, Japan. cfo36210@par.odn.ne.jp
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.