Longitudinal plaque redistribution during stent expansion

• Published in: The American journal of cardiology Vol. 86; no. 10; pp. 1069 - 1072
• Main Authors: Maehara, Akiko, Takagi, Atsushi, Okura, Hiroyuki, Hassan, Ali H.M, Bonneau, Heidi N, Honda, Yasuhiro, Yock, Paul G, Fitzgerald, Peter J
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 15.11.2000; Elsevier; Elsevier Limited
• Subjects: Angioplasty, Balloon, Coronary - methods; Bias; Biological and medical sciences; Cineradiography; Coronary Angiography; Coronary Disease - diagnostic imaging; Coronary Disease - pathology; Coronary Disease - therapy; Diseases of the cardiovascular system; Elasticity; Humans; Medical sciences; Predictive Value of Tests; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Recurrence; Severity of Illness Index; Stents; Treatment Outcome; Tunica Media - diagnostic imaging; Tunica Media - pathology; Ultrasonography, Interventional - methods; Sonography; Human; Endoprosthesis; Coronary artery; Instrumentation therapy; Exploration; Endovascular route; Stent; Vascular remodeling; Atherosclerotic plaque; Morphological analysis; Evolution; Tridimensional image; Mechanism of action
• DOI: 10.1016/S0002-9149(00)01161-9
• ISSN: 0002-9149

The purpose of this study was to clarify the 3-dimensional behavior of plaque during coronary stent expansion. Serial intravascular ultrasound (IVUS) studies, preintervention, and poststenting were evaluated in 32 patients treated with a single-balloon expandable tubular stent. External elastic membrane (EEM), lumen, stent, and plaque + media cross-sectional area were measured at 1-mm intervals through the entire stent as well as proximal and distal reference segments 5 mm from the stent edge. Volumetric calculations were based on Simpson’s rule. Overall, the plaque + media volume through the entire lesion did not change during stent expansion (218 ± 51 vs 217 ± 47 mm 3, p = 0.69). However, EEM and lumen volume increased significantly (EEM volume, 391 ± 84 vs 448 ± 87 mm 3 [p <0.0001]; lumen volume, 173 ± 52 vs 231 ± 54 mm 3 [p <0.0001]). The change in lumen volume correlated strongly with the change in EEM volume (r = 0.85, p <0.0001), but poorly with the change in plaque + media volume (r = 0.37, p = 0.03). Plaque + media volume decreased in the midstent zone (59 ± 14 vs 53 ± 11 mm 3, p = 0.0005), and increased in the distal stent zone (40 ± 11 vs 44 ± 9 mm 3, p = 0.003), but did not change in either the proximal stent zone or reference segments. The mechanism of stent expansion is a combination of vessel stretch and plaque redistribution, translating disease accumulation from the midstent zone to the distal stent zone.