(Circulation. 1999;99:1011-1014.)
© 1999 American Heart Association, Inc.
Clinical Investigation and Reports |
In-Stent Neointimal Proliferation Correlates With the Amount of Residual Plaque Burden Outside the Stent
An Intravascular Ultrasound Study
From the Catheterization Laboratory (F.P., M.T.M., A.P., E.L.), S. Camillo Hospital, Rome, Italy; and Centro Cuore Columbus (C.D.M., I.M., B.R., A.C.), Milan, Italy.
Correspondence to Antonio Colombo, MD, FACC, Centro Cuore Columbus, Via Buonarroti, 48, 20145 Milano, Italy.
Background—The aim of this study was to evaluate the relationship between residual plaque burden after coronary stent implantation and the development of late in-stent neointimal proliferation.
Methods and Results—Between January 1996 and May 1997, 50
patients underwent intravascular ultrasound (IVUS) interrogation at
6±1.2 months after coronary stent implantation in native
coronary arteries. IVUS images were acquired with a motorized
pullback, and cross-sectional measurements were performed within the
stents at 1-mm intervals. The following measurements were obtained: (1)
lumen area (LA), (2) stent area (SA), (3) area delimited by the
external elastic membrane (EEMA), (4) percent neointimal
area calculated as (SA-LA/SA)x100, and (5) percent residual plaque
area calculated as (EEMA-SA)/EEMAx100. Volume measurements within the
stented segments were calculated by applying Simpson's rule. In the
pooled data analysis of 876 cross sections, linear regression
showed a significant positive correlation between percent residual
plaque area and percent neointimal area
(r=0.50, y= 45.03+0.29x,
P<0.01). There was significant incremental increase in
mean percent neointimal area for stepwise increase in
percent residual plaque area. Mean percent neointimal area
was 16.3±10.3% for lesions with a percent residual plaque area of
<50% and 27.7±11% for lesions with a percent residual plaque area
of 
50% (P<0.001). The volumetric analysis
showed that the percent residual plaque volume was significantly
greater in restenotic lesions compared with
nonrestenotic lesions (58.7±4.3% versus 51.4±5.7%,
respectively; P<0.01).
Conclusions—Late in-stent neointimal proliferation has a direct correlation with the amount of residual plaque burden after coronary stent implantation, supporting the hypothesis that plaque removal before stent implantation may reduce restenosis.
Key Words: ultrasonics • stents • restenosis
This article has been cited by other articles:
 |
|
 |
|
  E. Romagnoli, G. M. Sangiorgi, J. Cosgrave, E. Guillet, and A. Colombo Drug-eluting stenting the case for post-dilation. J. Am. Coll. Cardiol. Intv., February 1, 2008; 1(1): 22 - 31. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Aziz, J. L Morris, R. A Perry, and R. H Stables Stent expansion: a combination of delivery balloon underexpansion and acute stent recoil reduces predicted stent diameter irrespective of reference vessel size Heart, December 1, 2007; 93(12): 1562 - 1566. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Erglis, I. Narbute, I. Kumsars, S. Jegere, I. Mintale, I. Zakke, U. Strazdins, and A. Saltups A Randomized Comparison of Paclitaxel-Eluting Stents Versus Bare-Metal Stents for Treatment of Unprotected Left Main Coronary Artery Stenosis J. Am. Coll. Cardiol., August 7, 2007; 50(6): 491 - 497. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. Tanabe, P. W. Serruys, M. Degertekin, G. Guagliumi, E. Grube, C. Chan, T. Munzel, J. Belardi, W. Ruzyllo, L. Bilodeau, et al. Chronic Arterial Responses to Polymer-Controlled Paclitaxel-Eluting Stents: Comparison With Bare Metal Stents by Serial Intravascular Ultrasound Analyses: Data From the Randomized TAXUS-II Trial Circulation, January 20, 2004; 109(2): 196 - 200. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Prati, T. Pawlowski, R. Gil, A. Labellarte, A. Gziut, E. Caradonna, A. Manzoli, A. Pappalardo, F. Burzotta, and A. Boccanelli Stenting of Culprit Lesions in Unstable Angina Leads to a Marked Reduction in Plaque Burden: A Major Role of Plaque Embolization?: A Serial Intravascular Ultrasound Study Circulation, May 13, 2003; 107(18): 2320 - 2325. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 V. Spanos, G. Stankovic, J. Tobis, and A. Colombo The challenge of in-stent restenosis: insights from intravascular ultrasound Eur. Heart J., January 2, 2003; 24(2): 138 - 150. [Full Text] [PDF]
|
|
|
|
|
|
I. P. Casserly, H. D. Aronow, P. Schoenhagen, H. Tsutsui, J. Popovich, M. Goormastic, J. J. Popma, S. E. Nissen, and E. M. Tuzcu Relationship between residual atheroma burden and neointimal growth in patients undergoing stenting: Analysis of the atherectomy before MULTI-LINK improves lumen gain and clinical outcomes trial intravascular ultrasound substudy J. Am. Coll. Cardiol., November 6, 2002; 40(9): 1573 - 1578. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Kataoka, E. Grube, Y. Honda, Y. Morino, S.-H. Hur, H. N. Bonneau, A. Colombo, C. Di Mario, G. Guagliumi, K. E. Hauptmann, et al. 7-Hexanoyltaxol-Eluting Stent for Prevention of Neointimal Growth: An Intravascular Ultrasound Analysis From the Study to COmpare REstenosis rate between QueST and QuaDS-QP2 (SCORE) Circulation, October 1, 2002; 106(14): 1788 - 1793. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Briguori, J. Tobis, T. Nishida, M. Vaghetti, R. Albiero, C. Di Mario, and A. Colombo Discrepancy between angiography and intravascular ultrasound when analysing small coronary arteries Eur. Heart J., February 1, 2002; 23(3): 247 - 254. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Hoffmann, P. Haager, G.S. Mintz, G. Kerckhoff, R. Schwarz, A. Franke, J. Vom Dahl, and P. Hanrath The impact of high pressure vs low pressure stent implantation on intimal hyperplasia and follow-up lumen dimensions; results of a randomized trial Eur. Heart J., November 1, 2001; 22(21): 2015 - 2024. [Abstract] [PDF]
|
|
|
|
|
|
S.-J. Park, M.-K. Hong, C. W. Lee, J.-J. Kim, J.-K. Song, D.-H. Kang, S.-W. Park, and G. S. Mintz Elective stenting of unprotected left main coronary artery stenosis: Effect of debulking before stenting and intravascular ultrasound guidance J. Am. Coll. Cardiol., October 1, 2001; 38(4): 1054 - 1060. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Windecker, I. Mayer, G. De Pasquale, W. Maier, O. Dirsch, P. De Groot, Y.-P. Wu, G. Noll, B. Leskosek, B. Meier, et al. Stent Coating With Titanium-Nitride-Oxide for Reduction of Neointimal Hyperplasia Circulation, August 21, 2001; 104(8): 928 - 933. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
I. P. Kay, A. J. Wardeh, K. Kozuma, G. Sianos, E. Regar, M. Knook, W. J. van der Giessen, A. Thury, J. M. R. Ligthart, V. M. A. Coen, et al. The pattern of restenosis and vascular remodelling after cold-end adioactive stent implantation Eur. Heart J., August 1, 2001; 22(15): 1311 - 1317. [Abstract] [PDF]
|
|
|
|
|
|
F Prati, E Arbustini, A Labellarte, B Dal Bello, L Sommariva, M T Mallus, A Pagano, and A Boccanelli Correlation between high frequency intravascular ultrasound and histomorphology in human coronary arteries Heart, May 1, 2001; 85(5): 567 - 570. [Abstract] [Full Text]
|
|
|
|
|
|
J. J. Wentzel, R. Krams, J. C. H. Schuurbiers, J. A. Oomen, J. Kloet, W. J. van der Giessen, P. W. Serruys, and C. J. Slager Relationship Between Neointimal Thickness and Shear Stress After Wallstent Implantation in Human Coronary Arteries Circulation, April 3, 2001; 103(13): 1740 - 1745. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Y. Kobayashi, Y. Honda, L. G. Christie, P. S. Teirstein, S. R. Bailey, C. L. Brown III, R. V. Matthews, A. C. De Franco, R. S. Schwartz, S. Goldberg, et al. Long-term vessel response to a self-expanding coronary stent: a serial volumetric intravascular ultrasound analysis from the ASSURE trial J. Am. Coll. Cardiol., April 1, 2001; 37(5): 1329 - 1334. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Okura, Y. Morino, A. Oshima, M. Hayase, M. R. Ward, J. J. Popma, R. E. Kuntz, H. N. Bonneau, P. G. Yock, and P. J. Fitzgerald Preintervention arterial remodeling affects clinical outcome following stenting: an intravascular ultrasound study J. Am. Coll. Cardiol., March 15, 2001; 37(4): 1031 - 1035. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. E. Nissen and P. Yock Intravascular Ultrasound : Novel Pathophysiological Insights and Current Clinical Applications Circulation, January 30, 2001; 103(4): 604 - 616. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Endo, H. Hirayama, O. Yoshida, T. Arakawa, T. Akima, T. Yamada, and M. Nanasato Arterial remodeling influences the development of intimal hyperplasia after stent implantation J. Am. Coll. Cardiol., January 1, 2001; 37(1): 70 - 75. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H.-W. Hopp, F. M. Baer, C. Ozbek, K. H. Kuck, B. Scheller, and for the AtheroLink Study Group A synergistic approach to optimal stenting: Directional coronary atherectomy prior to coronary artery stent implantation--the AtheroLink registry J. Am. Coll. Cardiol., November 15, 2000; 36(6): 1853 - 1859. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Hoffmann and G.S. Mintz Coronary in-stent restenosis--predictors, treatment and prevention Eur. Heart J., November 1, 2000; 21(21): 1739 - 1749. [PDF]
|
|
|
|
|
|
I. P. Kay, M. Sabate, M. A. Costa, K. Kozuma, M. Albertal, W. J. van der Giessen, A. J. Wardeh, J. M. R. Ligthart, V. M. A. Coen, P. C. Levendag, et al. Positive Geometric Vascular Remodeling Is Seen After Catheter-Based Radiation Followed by Conventional Stent Implantation but Not After Radioactive Stent Implantation Circulation, September 19, 2000; 102(12): 1434 - 1439. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. M. Ahmed, G. S. Mintz, N. J. Weissman, A. J. Lansky, A. D. Pichard, L. F. Satler, and K. M. Kent Mechanism of Lumen Enlargement During Intracoronary Stent Implantation : An Intravascular Ultrasound Study Circulation, July 4, 2000; 102(1): 7 - 10. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Sabate, J. P. A. Marijnissen, S. G. Carlier, I. P. Kay, W. J. van der Giessen, V. L. M. A. Coen, J. M. R. Ligthart, E. Boersma, M. A. Costa, P. C. Levendag, et al. Residual Plaque Burden, Delivered Dose, and Tissue Composition Predict 6-Month Outcome After Balloon Angioplasty and {beta}-Radiation Therapy Circulation, May 30, 2000; 101(21): 2472 - 2477. [Abstract] [Full Text] [PDF]
|
|