Preintervention arterial remodeling affects vessel stretch and plaque extrusion during coronary stent deployment as demonstrated by three-dimensional intravascular ultrasound.
Preintervention arterial remodeling affects vessel stretch and plaque extrusion during coronary stent deployment as demonstrated by three-dimensional intravascular ultrasound.
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DOI：
10.1016/s0002-9149(03)00526-5
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发表时间：
2003-07
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通讯作者：
C. von Birgelen;G. Mintz;H. Eggebrecht;J. Herrmann;Matthias Jasper;J. Brinkhoff;T. Neumann;D. Böse;D. Baumgart;A. Schmermund;H. Wieneke;M. Haude;R. Erbel
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作者：
C. von Birgelen;G. Mintz;H. Eggebrecht;J. Herrmann;Matthias Jasper;J. Brinkhoff;T. Neumann;D. Böse;D. Baumgart;A. Schmermund;H. Wieneke;M. Haude;R. Erbel
支架植入过程中管腔扩大的机制可能受到动脉重塑的显著影响。为了评估病变重塑的影响，我们对55个冠状动脉病变进行了三维血管内超声（IVUS）分析，分析了球囊扩张支架部署前后的情况。进行标准定量分析，以重塑指数（靶部位以近端和远端参考节段血管面积均值划分）评价动脉重构，将病变分为A组（重塑指数≤1，阴性或中度重塑，n = 40）和B组（重塑指数>.1，阳性重塑，n = 15）病变。两组55例患者的特点及介入方式相似。IVUS显示支架植入导致a组和B组病变的管腔和血管尺寸增加，斑块大小减小（p均≤0.001）。支架内管腔增加的程度几乎相同，但其机制不同：(1)A组血管拉伸更大（最小管腔部位p <0.002）；(2) B组斑块压迫（或栓塞）倾向于更大（p = 0.05，沿整个支架段）；(3)两组支架内斑块均出现再分布（p <0.005）；(4)只有B组牙菌斑挤压到远端参考节段（p <0.01）。因此，冠状动脉病变的重塑模式对支架部署期间管腔扩大的机制有重要影响。阳性重塑的病变比阴性重塑的病变表现出更多的斑块挤压到远端参比，更少的支架引起的血管拉伸。
The mechanisms of lumen enlargement during stent implantation may be significantly affected by arterial remodeling. To assess effects of lesion remodeling, we performed 3-dimensional intravascular ultrasound (IVUS) analyses in 55 coronary lesions before and after deployment of balloon-expandable stents. Standard quantitative analysis was performed, and arterial remodeling was assessed by the remodeling index (target site divided by mean of proximal and distal reference segment vessel areas), which classified lesions into group A (remodeling index ≤1, negative or intermediate remodeling, n = 40) or group B (remodeling index >1, positive remodeling, n = 15) lesions. Characteristics of the 55 patients and the interventional procedures were similar in the 2 groups. IVUS demonstrated that stenting resulted in increased lumen and vessel dimensions and in a reduced plaque size (p ≤0.001 each) in both group A and group B lesions. The extent of lumen increase inside the stents was almost identical, but resulted from different mechanisms: (1) vessel stretch was greater in group A (p <0.002 at minimum lumen site); (2) plaque compression (or embolization) tended to be greater in group B (p = 0.05, along entire stented segment); (3) plaque redistribution within the stent was observed in both groups (p <0.005 both); and (4) significant (p <0.01) plaque extrusion into the distal reference segment was found in group B only. Thus, the remodeling pattern of coronary lesions has a significant impact on the mechanisms of lumen enlargement during stent deployment. Lesions with positive remodeling show more plaque extrusion into the distal reference and less stent-induced vessel stretch than those with negative remodeling.