Impact of preinterventional arterial remodeling on in-stent neointimal hyperplasia and in-stent restenosis after coronary stent implantation - An intravascular ultrasound study

Background: Patterns of arterial remodeling during the course of plaque development have been shown to play an important role in both the progression of de novo atherosclerosis and in the restenotic process following coronary intervention. The aim of the present prospective study was to evaluate the effect of pre-interventional arterial remodeling on in-stent neointimal hyperplasia (NIH) and in-stent restenosis (ISR) after stenting. Methods and Results: Pre-interventional arterial remodeling was assessed in 85 native coronary lesions by using intravascular ultrasound (IVUS). The remodeling index (RI) was 1.09±0.20 in the positive remodeling (PR)/intermediate remodeling (IR) group and 0.84±0.12 in the negative remodeling (NR) group. The plaque plus media cross sectional area (P&M CSA) at pre-intervention and NIH CSA at follow-up in the minimal lumen CSA were significantly larger in the PR/IR group (9.2±2.9 mm² vs 6.2±1.8 mm², 3.3±1.2 mm² vs 1.5±0.9 mm²; p=0.001, p=0.001, respectively). On 3-dimensional analysis of IVUS images at follow-up, the lumen volume was significantly smaller in the PR/IR group than that in the NR group (62±15 mm³ vs 75±20 mm³; p=0.001), and neointima hyperplasia volume was significantly larger in the PR/IR group than that in the NR group (46± 15 mm³ vs 26±10 mm³; p=0.001). A significant positive correlation was found between pre-interventional R1 and follow-up NIH CSA (r=0.25, p=0.022). The incidence of ISR and repeat intervention was significantly higher in the PR/IR group (30.8% vs 18.2%, 28.8% vs 15.2%; p=0.032, 0.035, respectively). Conclusion: Measuring pre-interventional arterial remodeling patterns by IVUS may be helpful to stratify lesions at high-risk of ISR.