Morphological Effects on In-Stent Restenosis Assessed by Intravascular Ultrasound Imaging.

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概要

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• The purpose of this study was to evaluate the rupture and dissection of the vessel wall immediately after balloon dilatation by intravascular ultrasound (IVUS) imaging and to predict restenosis in patients who underwent subsequent coronary stent implantation. Stent implantation improves the long-term results of coronary angioplasty by reducing lesion elastic recoil and arterial remodeling. However, serveral studies have suggested that neointimal hyperplasia is the cause of in-stent restenosis. We recruited 60 patients in whom IVUS studies were performed immediately after successful balloon dilatation and just before stent implantation. We compared IVUS parameters with 6-month follow-up quantitative coronary angiography. This was performed in 51 lesions of 51 patients (85%). Qualitative analysis included assessment of plaque composition, plaque eccentricity, plaque fracture and the presence of dissection. In addition, minimal luminal diameter, percent diameter stenosis, percent area stenosis and plaque burden were quantitatively analyzed. Two morphological patterns after balloon dilatation were classified by IVUS. Type I was defined as absence or partial tear of the plaque without disclosure of the media to lumen (22 lesions). Type II was defined as a split in the plaque or dissection of the vessel wall with disclosure of the media to the lumen (29 lesions). At 6 months follow-up, angiographic restenosis occurred in 17 of the 51 lesions (33%). Restenosis was significantly (p < 0.05) more likely to occur in type II (13/29: 45% incidence) than in type I (4/22: 18% incidence). The assessment of plaque morphology immediately after balloon dilatation and before stent implantation provides important therapeutic and prognostic implications.

• International Heart Journal刊行会の論文

著者

• Biro Sadatoshi

  First Department of Internal Medicine, Faculty of Medicine, Kagoshima University

• Kihara Koichi

  First Department Of Internal Medicine Faculty Of Medicine Kagoshima University

• YAMAGUCHI Tsuyoshi

  First Department of Pathology, Nagoya City University, Medical School

• Nakajima Hitoshi

  First Department Of Internal Medicine Hirosaki University School Of Medicine

• Tei Chuwa

  First Department Of Internal Medicine Faculty Of Medicine Kagoshima University

• Yoshitama Takashi

  First Department of Internal Medicine, Kagoshima University

• Nakano Fumio

  First Department of Internal Medicine, Faculty of Medicine, Kagoshima University

• HAMASAKI Shuichi

  First Department of Internal Medicine, Faculty of Medicine, Kagoshima University, Kagoshima, Japan

• KIHARA Koichi

  First Department of Internal Medicine, Faculty of Medicine, Kagoshima University, Kagoshima, Japan

• BIRO Sadatoshi

  First Department of Internal Medicine, Faculty of Medicine, Kagoshima University, Kagoshima, Japan

• ARIMA Shinichi

  First Department of Internal Medicine, Faculty of Medicine, Kagoshima University, Kagoshima, Japan

• NAKAO Shoichiro

  First Department of Internal Medicine, Faculty of Medicine, Kagoshima University, Kagoshima, Japan

• FUKUMOTO Nobuhisa

  First Department of Internal Medicine, Faculty of Medicine, Kagoshima University, Kagoshima, Japan

• KAMEKOU Masahiro

  First Department of Internal Medicine, Faculty of Medicine, Kagoshima University, Kagoshima, Japan

• KIYONAGA Kazuaki

  First Department of Internal Medicine, Faculty of Medicine, Kagoshima University, Kagoshima, Japan

• YOSHITAMA Takashi

  First Department of Internal Medicine, Faculty of Medicine, Kagoshima University, Kagoshima, Japan

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