Relation between preintervention remodeling and late arterial responses tocoronary angioplasty or atherectomy

We used the serial intravascular ultrasound (IVUS) data from the Serial Ult rasound REstenosis trial to explain why positive remodeling lesions have a higher rate of clinical restenosis after non-stent interventions. Serial IV US was performed before intervention and immediately and 1 and 6 months aft er percutaneous transluminal coronary angioplasty (n = 35) or directional c oronary atherectomy (n = 26). External elastic membrane, lumen, and plaque + media (external elastic membrane minus lumen) areas were measured at the reference and stenosis. Stenoses were divided into 3 groups: positive remod eling (lesion greater than proximal reference external elastic membrane), i ntermediate remodeling (lesion external elastic membrane smaller than proxi mal reference but larger than distal reference), and negative remodeling (l esion equal to or less than distal reference external elastic membrane). Th e early (postintervention to 1 month) and late (1- to 6-month) changes in l esion external elastic membrane and plaque + media areas were compared. An early increase in plaque + media erect was associated with an equal or grea ter increase in external elastic membrane area in positive (r = 0.78, p <0. 0001), intermediate (r = 0.69, p <0.0001), and negative (r = 0.59, p = 0.00 03) remodeling lesions. A late (1- to 6-month) decrease in external elastic membrane area correlated inversely with the early increase in plaque + med ia area in positive (r = 0.77, p 0.0002) and intermediate (r = 0.45, p 0.00 03), but not in negative (r = 0.02, p = 0.9) remodeling lesions. In positiv e remodeling lesions, the early increase in plaque + media area was associa ted with bath an exaggerated early increase and late decrease in external e lastic membrane area. Positive remodeling lesions have an exaggerated early increase in external elastic membrane area and, especially, an exaggerated late decrease in external elastic membrane area after percutaneous translu minal coronary angioplasty and directional coronary atherectomy. This may e xplain that the increased clinical restenosis after positive remodeling les ions is treated with non-stent interventions. (C) 2001 by Excerpta Medica, Inc.