Application of intravascular ultrasound in remodelling studies

Arterial remodelling is an important determinant of luminal narrowing in de novo atherosclerosis as well as in restenosis following balloon angioplasty. To date, intravascular ultrasound is the best diagnostic modality to study changes in arterial size in vivo. The role of arterial wall remodelling in de novo atherosclerosis and restenosis has been well established by intravascular ultrasound studies. Single intravascular ultrasound studies have demonstrated that the artery may enlarge, fail to enlarge or even shrink if plaque accumulates. In restenosis studies, serial intravascular ultrasound studies have allowed examination of the remodelling process over time and have shown that arterial shrinkage and not intimal hyperplasia is the predominant factor responsible for luminal narrowing after balloon angioplasty. This article will focus on the applicability of intravascular ultrasound to the study of vascular remodelling in de novo atherosclerosis, in restenosis after balloon angioplasty, atherectomy and stenting, in saphenous vein grafts and in the coronary arteries of transplanted hearts.