Angioscopic complex lesions are predominantly compensatory enlarged: an angioscopy and intracoronary ultrasound study

Objectives: Atherosclerotic remodeling of the coronary artery may lead to c ompensatory enlargement or to shrinkage. Post-mortem data suggest a relatio n between compensatory enlargement and histopathological markers of plaque vulnerability. In patients that required a coronary intervention, we invest igated retrospectively the relation between the angioscopic appearance and the remodeling mode of the culprit lesion. Methods: In 34 patients, coronar y angioscopy and intracoronary ultrasound (ICUS) imaging was performed acro ss the culprit lesion before the intervention. Only single de novo lesions were included. With angioscopy, lesions with a smooth surface without throm bus were classified as smooth, whereas lesions with an irregular surface wi th or without thrombus were classified as complex. With ICUS, remodeling of the culprit lesions was determined by the relative cross-sectional vessel area (lesion vessel area/reference vessel area)x100%. Lesions were divided into three groups: compensatory enlargement (relative vessel area greater t han or equal to 105%), no-remodeling (relative vessel area between 95 and 1 05%) and shrinkage (relative vessel area less than or equal to 95%). Result s: In 22 patients good images were obtained with both imaging modalities. M ore complex lesions were compensatory enlarged compared to shrunken lesions , whereas more smooth lesions were shrunken compared to compensatory enlarg ed lesions, 8/9 versus 2/7 and 5/7 versus 1/9, I respectively (p=0.035). Co nclusions: In patients selected for coronary intervention, angioscopic comp lex atherosclerotic lesions were found predominantly in compensatory enlarg ed arterial segments, whereas smooth lesions were found predominantly in sh runken arterial segments. (C) 1999 Elsevier Science B.V. All rights reserve d.