This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Ahmed, J. M. Articles by Kent, K. M. Search for Related Content PubMed PubMed Citation Articles by Ahmed, J. M. Articles by Kent, K. M. Related Collections Catheter-based coronary interventions: stents

(Circulation. 2000;102:7.)
© 2000 American Heart Association, Inc.

Brief Rapid Communications

Mechanism of Lumen Enlargement During Intracoronary Stent Implantation

An Intravascular Ultrasound Study

Javed M. Ahmed, MD; Gary S. Mintz, MD; Neil J. Weissman, MD; Alexandra J. Lansky, MD; Augusto D. Pichard, MD; Lowell F. Satler, MD; Kenneth M. Kent, MD, PhD

From the Intravascular Ultrasound Imaging and Cardiac Catheterization Laboratories, Washington Hospital Center, Washington, DC.

Correspondence to Gary S. Mintz, MD, 110 Irving St NW, Suite 4B1, Washington, DC 20010. E-mail gsm1{at}mhg.edu

Background—Intravascular ultrasound analysis has assessed mechanisms of lumen enlargement after nonstent interventions, but not after stenting.

Methods and Results—Preintervention and postintervention intravascular ultrasound was used to study 25 de novo native coronary lesions treated with single MultiLink stents without preatheroablation. External elastic membrane, lumen, and plaque and media (P&M) areas were measured every 1 mm to include the lesion and reference segments that were 5 mm proximal and distal to it. Lesion mean lumen area increased from 4.0±1.0 mm² before the intervention to 8.8±2.0 mm² after the intervention (P<0.0001) as a result of an increase in mean external elastic membrane area (14.2±2.7 to 16.1±3.0 mm², P<0.0001) and a decrease in mean P&M area (10.2±2.2 to 7.2±1.8 mm², P<0.0001). The decrease in lesion P&M was accompanied by an increase in both proximal reference mean P&M (7.0±1.9 to 8.4±2.0 mm², P<0.0001) and distal reference mean P&M (5.8±2.1 to 7.2±2.1 mm², P<0.0001). Volumetric analysis showed an axial redistribution of plaque away from the center of the lesion toward the reference segments to increase the plaque burden in both the proximal and distal reference segments. Total (lesion plus reference) mean P&M decreased from 8.6±2.1 to 7.5±1.8 mm² (P<0.0001).

Conclusions—The mechanisms of lumen enlargement after stenting involved (1) significant axial redistribution of plaque from the lesion into the reference segments, (2) vessel expansion, and (3) either plaque embolization or compression.

Key Words: stents • ultrasonics • imaging

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]

				D. R. Holmes Jr, P. Teirstein, L. Satler, M. Sketch, J. O'Malley, J. J. Popma, R. E. Kuntz, P. J. Fitzgerald, H. Wang, E. Caramanica, et al. Sirolimus-Eluting Stents vs Vascular Brachytherapy for In-Stent Restenosis Within Bare-Metal Stents: The SISR Randomized Trial JAMA, March 15, 2006; 295(11): 1264 - 1273. [Abstract] [Full Text] [PDF]

				J. Herrmann Peri-procedural myocardial injury: 2005 update Eur. Heart J., December 1, 2005; 26(23): 2493 - 2519. [Abstract] [Full Text] [PDF]

				H. Sato, H. Iida, A. Tanaka, H. Tanaka, S. Shimodouzono, E. Uchida, T. Kawarabayashi, and J. Yoshikawa The decrease of plaque volume during percutaneous coronary intervention has a negative impact on coronary flow in acute myocardial infarction: A major role of percutaneous coronary intervention-induced embolization J. Am. Coll. Cardiol., July 21, 2004; 44(2): 300 - 304. [Abstract] [Full Text] [PDF]

				Y. Louvard, T. Lefevre, and M.-C. Morice Percutaneous coronary intervention for bifurcation coronary disease Heart, June 1, 2004; 90(6): 713 - 722. [Full Text] [PDF]

				M.P. Siegenthaler, J. Martin, K. Pernice, T. Doenst, S. Sorg, G. Trummer, O. Friesewinkel, and F. Beyersdorf The Jarvik 2000 is associated with less infections than the HeartMate left ventricular assist device Eur. J. Cardiothorac. Surg., May 1, 2003; 23(5): 748 - 755. [Abstract] [Full Text] [PDF]

				B E Bouma, G J Tearney, H Yabushita, M Shishkov, C R Kauffman, D DeJoseph Gauthier, B D MacNeill, S L Houser, H T Aretz, E F Halpern, et al. Evaluation of intracoronary stenting by intravascular optical coherence tomography Heart, March 1, 2003; 89(3): 317 - 320. [Abstract] [Full Text] [PDF]

				G Finet, N J Weissman, G S Mintz, L F Satler, K M Kent, J R Laird, G A Adelmann, A E Ajani, M T Castagna, G Rioufol, et al. Mechanism of lumen enlargement with direct stenting versus predilatation stenting: influence of remodelling and plaque characteristics assessed by volumetric intracoronary ultrasound Heart, January 1, 2003; 89(1): 84 - 90. [Abstract] [Full Text] [PDF]

				J. A. Ambrose and E. E. Martinez A New Paradigm for Plaque Stabilization Circulation, April 23, 2002; 105(16): 2000 - 2004. [Abstract] [Full Text] [PDF]

				H.-S. Kim, R. Waksman, Y. Cottin, M. Kollum, B. Bhargava, R. Mehran, R. C. Chan, and G. S. Mintz Edge stenosis and geographical miss following intracoronary gamma radiation therapy for in-stent restenosis J. Am. Coll. Cardiol., March 15, 2001; 37(4): 1026 - 1030. [Abstract] [Full Text] [PDF]