March 2, 1999Circulation163 citations
In-Stent Neointimal Proliferation Correlates With the Amount of Residual Plaque Burden Outside the Stent
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Key Points
- The study aims to assess the relationship between residual plaque burden after stenting and later neointimal proliferation.
- Analysis of intravascular ultrasound (IVUS) images from 50 patients at 6 months post-stenting
- Measurements included lumen area, stent area, and percent neointimal and residual plaque areas
- Statistical analysis performed using linear regression and volumetric comparisons
- Significant positive correlation found between percent residual plaque area and percent neointimal area (r=0.50, P<0.01)
- Mean percent neointimal area was 16.3% for <50% plaque area and 27.7% for >50% plaque area (P<0.001)
- Percent residual plaque volume was greater in restenotic lesions (58.7%) compared to nonrestenotic lesions (51.4%, P<0.01)
Abstract
BACKGROUND: The aim of this study was to evaluate the relationship between residual plaque burden after coronary stent implantation and the development of late in-stent neointimal proliferation. METHODS AND RESULTS: Between January 1996 and May 1997, 50 patients underwent intravascular ultrasound (IVUS) interrogation at 6+/-1.2 months after coronary stent implantation in native coronary arteries. IVUS images were acquired with a motorized pullback, and cross-sectional measurements were performed within the stents at 1-mm intervals. The following measurements were obtained: (1) lumen area (LA), (2) stent area (SA), (3) area delimited by the external elastic membrane (EEMA), (4) percent neointimal area calculated as (SA-LA/SA)x100, and (5) percent residual plaque area calculated as (EEMA-SA)/EEMAx100. Volume measurements within the stented segments were calculated by applying Simpson's rule. In the pooled data analysis of 876 cross sections, linear regression showed a significant positive correlation between percent residual plaque area and percent neointimal area (r=0.50, y= 45.03+0.29x, P/=50% (P<0.001). The volumetric analysis showed that the percent residual plaque volume was significantly greater in restenotic lesions compared with nonrestenotic lesions (58.7+/-4.3% versus 51.4+/-5.7%, respectively; P<0.01). CONCLUSIONS: Late in-stent neointimal proliferation has a direct correlation with the amount of residual plaque burden after coronary stent implantation, supporting the hypothesis that plaque removal before stent implantation may reduce restenosis.