Intravascular ultrasonic analysis of plaque characteristics associated with coronary artery remodeling

We sought to determine the patient and plaque characteristics associated wi th the different forms of arterial remodeling as seen by intravascular ultr asound (IVUS) before coronary intervention. Remodeling in response to plaqu e accumulation may occur in the form of compensatory enlargement and/or foc al vessel contraction, Previous studies report variation in the frequency a nd form of arterial remodeling. We performed preintervention IVUS imaging o n 169 patients, Vessels were categorized as exhibiting compensatory enlarge ment or focal contraction if the arterial area at the lesion was larger or smaller, respectively, than both proximal and distal reference arterial are as; otherwise the artery was considered not to have undergone significant r emodeling, Calcification was assessed and noncalcified plaque density was m easured by videodensitometry, Sixty-one of 169 patients (66 narrowings) (46 men and 15 women, age 56 +/- 11 years) had adequate reference segments, Re modeling occurred in 43 of 66 patients (65%): compensatory enlargement in 2 7 of 66 (41%) and focal contraction in 16 of 66 (24%). Lesions with focal c ontraction had significantly smaller arterial area (13.3 +/- 3.3 vs 18.1 +/ - 7.0 mm(2), p = 0.02) and plaque area (9.5 +/- 2.8 vs 13.7 +/- 5.5 mm(2), p <0.01). Cross-sectional stenosis was similar (71 +/- 9% vs 75 +/- 10%, p NS), as was plaque density (p = 0.20), eccentricity, and calcium. Patient a ge, gender, and lesion location were not related to the form of remodeling, Similarly, history of diabetes, hypercholesterolemia, or hypertension was not predictive. Smoking was the only risk factor associated with focal cont raction (p <0.01). Thus, whereas compensatory enlargement appears to be the most common form of coronary artery remodeling, focal contraction occurs m ore often in smokers. (C) 1999 by Excerpta Medica, Inc.