Coronary artery remodeling in atherosclerotic disease: an intravascular ultrasonic study in vivo
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1Department of Cardiology, University of Essen, Germany.
Insights
Coronary arteries enlarge to compensate for atherosclerosis, a process visible with intravascular ultrasound. This compensatory enlargement means coronary angiography may miss early signs of coronary artery disease.
Area of Science:
- Cardiovascular Research
- Medical Imaging
- Pathology
Background:
- Pathologic studies confirm coronary arteries enlarge to compensate for atherosclerosis.
- Compensatory enlargement is a key feature of atherosclerotic coronary arteries.
Purpose of the Study:
- To assess coronary artery remodeling in vivo using intravascular ultrasound.
- To evaluate the relationship between plaque area and vessel enlargement in coronary atherosclerosis.
Main Methods:
- Intravascular ultrasound (IVUS) was used to examine 46 patients with non-calcified plaques.
- Vessel, lumen, and plaque areas were measured in atherosclerotic and normal coronary segments.
- Analysis included 92 atherosclerotic segments with stenosis ranging from 9.2% to 92.8%.
Main Results:
- The vessel area of atherosclerotic segments was significantly larger than normal proximal segments (20.4 vs. 18.7 mm2, P=0.018).
- Vessel area increased proportionally with plaque area, described by the equation y = 23.5(1-e-0.35x).
- The difference in vessel area correlated with stenosis percentage up to 45% (r=0.53, P<0.005).
Conclusions:
- Intravascular ultrasound can effectively evaluate coronary artery remodeling in vivo.
- Compensatory enlargement of coronary arteries can mask early atherosclerosis on standard angiography.
- Angiography may fail to detect or exclude early signs of coronary atherosclerosis due to vessel remodeling.
Background:
Pathologic studies have revealed that coronary arteries undergo compensatory enlargement in the presence of atherosclerosis.
Methods:
In order to assess coronary artery remodeling in vivo, we used intravascular ultrasound to examine 46 patients (36 men and 10 women; aged 58.2 +/- 6.8 years) with non-calcified plaques. The vessel, lumen, and plaque areas of the atherosclerotic and of normal proximal and distal segments were determined.
Results:
A total of 92 atherosclerotic segments were analyzed. The degree of stenosis ranged from 9.2 to 92.8% (mean 34.1 +/- 16.9%) and the plaque area from 2 to 19.6 mm2 (mean 6.3 +/- 3.6 mm2). The vessel area of the atherosclerotic segment (mean 20.4 +/- 7.3 mm2) was larger than that of the proximal segment (mean 18.7 +/- 7.3 mm2, P = 0.018). The vessel area increased in proportion to plaque area. This relationship can be described using the equation y = 23.5(1-e-0.35x). The difference between the vessel area in the atherosclerotic segment and that in the proximal normal segment correlated with the percentage of stenosis (r = 0.53, P < 0.005) until the degree of stenosis exceeded 45%.
Conclusion:
This study indicates that coronary artery remodeling, previously observed in pathologic studies, can be evaluated using intravascular ultrasound in vivo. As a result of the compensatory enlargement of the vessel, coronary angiography cannot be used to detect or exclude the early signs of coronary atherosclerosis.