Abstract
Previous studies have shown that (1) stents reduce restenosis, (2) stents do not recoil, and (3) geometric remodeling may be an important contributing factor in restenosis. Therefore, to understand the mechanisms by which stents reduce restenosis, we analyzed serial (post-intervention and follow-up @ 5.0 ± 2.9 months) intravascular ultrasound and quantitative angiographic studies in 33 stented lesions and compared the results to 135 nonstented lesions treated with various devices (30 PTCA, 57 directional and 26 rotational atherectomy, and 22 excimer laser angioplasty). Post-intervention and followup external elastic membrane (EEM), stent, and lumen areas were used to calculate (1) plaque area, (2) late lumen loss (Δ lumen area), (3) geometric remodeling (Δ EEM area or Δ stent area in stented lesions and Δ EEM area in nonstented lesions), and (4) tissue growth Δ (stent-lumen) area in stented lesions and Δ plaque area in nonstented lesions. Stent Non-stent p Post-intervention EEM area (mm 2 ) 29.3 ± 118 204 ± 65 < 0.0001 Lumen area (mm 2 ) 8.5 ± 39 6.1 ± 2.4 < 0.0001 Plaque area (mm 2 ) 20.9 ± 9.3 14.3 ± 5.7 < 0.0001 Angiographic % diameter stenosis 9 ± 18 19 ± 14 0.0011 Follow-up EEM area (mm 2 ) 27.7 ± 9.5 187 ± 6.0 < 0.0001 Lumen area (mm 2 ) 6.5 ± 4.4 35 ± 3.0 < 0.0001 Plaque area (mm 2 ) 22.0 ± 8.0 15.2 ± 5.5 < 0.0001 Angiographic % diameter stenosis 36 ± 18 51 ± 26 0.005 Restenosis # (%) 8(23%) 77(57%) 0.0017 Late lumen loss (mm 2 ) 2.4 ± 2.6 2.6 ± 2.7 NS Remodeling (mm 2 ) 02 ± 13 1.7 ± 2.9 0.0061 Tissue growth (mm 2 ) 2.2 ± 2.4 1.0 ± 2.3 0.0076 Geometric remodeling is less (0.2 ± 1.3 vs 1.7 ± 2.9 mm 2 ) and tissue growth is greater (2.2 ± 2.4 vs 1.0 ± 2.3 mm 2 ) in stented lesions than in nonstented lesions. Stents reduce restenosis by achieving a better primary (post-procedural) result and by eliminating geometric remodeling. The elimination of geometric remodeling offsets a stent-related increase in plaque mass (tissue growth or neointimal hyperplasia) to prevent restenosis.
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