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. 2001 Jan;85(1):73–79. doi: 10.1136/heart.85.1.73

Three dimensional intravascular ultrasonic assessment of the local mechanism of restenosis after balloon angioplasty

M Costa 1, K Kozuma 1, A Gaster 1, W J van der Giessen 1, M Sabate 1, D Foley 1, I Kay 1, J Ligthart 1, P Thayssen 1, M J van den Brand 1, P J de Feyter 1, P Serruys 1
PMCID: PMC1729576  PMID: 11119468

Abstract

OBJECTIVE—To assess the mechanism of restenosis after balloon angioplasty.
DESIGN—Prospective study.
PATIENTS—13 patients treated with balloon angioplasty.
INTERVENTIONS—111 coronary subsegments (2 mm each) were analysed after balloon angioplasty and at a six month follow up using three dimensional intravascular ultrasound (IVUS).
MAIN OUTCOME MEASURES—Qualitative and quantitative IVUS analysis. Total vessel (external elastic membrane), plaque, and lumen volume were measured in each 2 mm subsegment. Delta values were calculated (follow up − postprocedure). Remodelling was defined as any (positive or negative) change in total vessel volume.
RESULTS—Positive remodelling was observed in 52 subsegments while negative remodelling occurred in 44. Remodelling, plaque type, and dissection were heterogeneously distributed along the coronary segments. Plaque composition was not associated with changes in IVUS indices, whereas dissected subsegments had a greater increase in total vessel volume than those without dissection (1.7 mm3 v −0.33 mm3, p = 0.04). Change in total vessel volume was correlated with changes in lumen (p < 0.05, r = 0.56) and plaque volumes (p < 0.05, r = 0.64). The site with maximum lumen loss was not the same site as the minimum lumen area at follow up in the majority (n = 10) of the vessels. In the multivariate model, residual plaque burden had an influence on negative remodelling (p = 0.001, 95% confidence interval (CI) −0.391 to −0.108), whereas dissection had an effect on total vessel increase (p = 0.002, 95% CI 1.168 to 4.969).
CONCLUSIONS—The mechanism of lumen renarrowing after balloon angioplasty appears to be determined by unfavourable remodelling. However, different patterns of remodelling may occur in individual injured coronary segments, which highlights the complexity and influence of local factors in the restenotic process.


Keywords: balloon angioplasty; intravascular ultrasound; remodelling; restenosis

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Figure 1  .

Figure 1  

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Standard display of the results by three dimensional longitudinal reconstruction of the intravascular ultrasound cross sectional images using an ECG gated pullback. Upper outside panels: longitudinal reconstruction images immediately after the procedure (left side) and at follow up (right side). White arrows indicate the anatomical landmarks (side branches and calcium). Upper inside panels: matched cross sections immediately after the procedure (left side) and at follow up (right side). Lower panels: subsequent volumetric quantification immediately after the procedure (left side) and at follow up (right side). The area values of the lumen (lower line) and total vessel (upper line) form the boundaries of the grey zone, which represent the plaque-media complex, and a single line depicts the absolute area value of plaque-media complex. Black arrows indicate the site of the minimum lumen area (MLA).

Figure 2  .

Figure 2  

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Correlation between remodelling (ΔTVV), changes in plaque volume (ΔPV), and changes in lumen volume (ΔLV). Upper panels: correlations in all subsegments (n = 111). Middle panels: correlations at the subsegments of minimum lumen area at follow up (n = 13). Lower panels: correlations at the maximum late lumen loss sites (n = 13). ΔTVV, change in total vessel volume; ΔPV, change in plaque volume; ΔLV, change in lumen volume. *Significant correlation (p < 0.01).

Figure 3  .

Figure 3  

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Comparison of relative changes in total vessel volume (RDTVV), lumen volume (RDLV), and plaque volume (RDPV) between subsegments with negative (n = 44) and positive (n = 52) remodelling.

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