Type and extent of vascular remodeling in significant coronary lesions: An intravascular ultrasound study
Füssl, R.; Kranenberg, E.; Kiausch, U.; Baer, F.; Höpp, H.W.
Zeitschrift für Kardiologie 88(10): 780-787
1999
ISSN/ISBN: 0300-5860 PMID: 10552180 Document Number: 505304
The purpose of this study was to assess the dimension of regional vascular remodeling and its influence on lumen narrowing in vivo. Sixty-three patients with 68 coronary lesions were imaged by intravascular ultrasound before transcatheter therapy. Quantitative measurements of lumen area, vessel area, and plaque area were performed at the lesion site and at the proximal and distal reference site. Area stenosis was calculated as plaque area/vessel area cntdot 100. The extent of remodeling was quantified by a remodeling index (RI = stenosis vessel area - mean reference vessel area/mean reference vessel area cntdot 100). Additionally, three different groups of vascular remodeling were defined: 1) positive remodeling = stenosis vessel area > maximal reference vessel area; 2) intermediate remodeling = maximal reference vessel area gtoreq stenosis vessel area gtoreq minimal reference vessel area; 3) negative remodeling = stenosis vessel area < minimal reference vessel area. In 57% of lesions stenosis vessel area was not in between the proximal and distal reference area: 29% of lesions (20/68) had positive, 28% (19/68) negative, and 43% (29/68) intermediate remodeling. Overall remodeling index averaged -0.8 +- 19.7%. In the negative remodeling group, reduction of vessel area contributed to 40 +- 21% of lumen narrowing, in the positive remodeling group, stenosis vessel area was 21 +- 12% enlarged (p < 0.001). Lesions with negative remodeling exhibit a lesser plaque area, lesions with positive remodeling a larger than other vessels (8.2 +- 2.4 mm2, 13.8 +- 3.7 mm2, 10.8 +- 3.7 mm2; p < 0.001). Distinct vascular remodeling occurred in the majority of atheosclerotic lesions and is a bidirectional process. Overall, the extent and the frequency of positive and negative remodeling was almost balanced. In lesions with negative remodeling the plaque area was significantly lesser than in other lesions.