Remodeling of Human Coronary Arteries Undergoing Coronary Angioplasty or Atherectomy

BACKGROUND: Recently, long-term constriction of the vessel has been suggested as an alternative mechanism of restenosis after coronary angioplasty. METHODS AND RESULTS: To understand remodeling of human coronary arteries undergoing coronary angioplasty or atherectomy, serial intravascular ultrasonographic examinations were performed at preintervention and postintervention examinations and at 24 hours, 1 month, and 6 months. Complete serial data were obtained in 61 lesions (balloon angioplasty, 35 lesions; directional atherectomy, 26 lesions). Lumen area improved from 6.81+/-2.24 mm2 after intervention to 8.22+/-2.79 mm2 at 1 month (P=.0001) and decreased to 4.88+/-2.86 mm2 at 6 months (P=.0001). Vessel area enlarged from 17.32+/-5.35 mm2 after intervention to 19.39+/-5.33 mm2 at 1 month (P=.0001) and decreased to 16.33+/-5.54 mm2 at 6 months (P=.0001). Plaque+media area increased significantly from postintervention examination to 24 hours (10.51+/-4.38 versus 10.96+/-4.49 mm2, P=.0008) and from 24 hours to 6 months (10.96+/-4.49 versus 11.45+/-4.45 mm2, P=.03). Changes in lumen area in each study interval correlated more closely with changes in vessel area than with changes in plaque+media area. Restenotic lesions compared with nonrestenotic lesions had a greater decrease in the vessel area between 1 month and 6 months (-4.33+/-2.73 versus -2.49+/-2.15 mm2, P=.006) and greater increase in the plaque+media area both within 24 hours (0.84+/-1.22 versus 0.27+/-0.38 mm2, P=.04) and between 24 hours and 6 months (1.19+/-2.19 versus 0.18+/-1.46 mm2, P=.04). CONCLUSIONS; Remodeling after coronary angioplasty or atherectomy was characterized by early adaptive enlargement and late constriction of the vessel.