Stent implantation neutralizes the impact of preintervention arterial remodeling on subsequent target lesion revascularization

Abstract

Positive remodeling of the atherosclerotic arterial wall occurs to compensate for plaque accumulation. However, more recent studies, primarily using intravascular ultrasound (IVUS) in vivo, have emphasized that in certain lesions, inadequate or negative arterial remodeling contributes to lumen compromise. Possible explanatory mechanisms include failure of positive adaptive remodeling, initial positive remodeling followed by late arterial shrinkage, and restriction of the extent of positive remodeling due to certain plaque elements (i.e., calcium or dense fibrous tissue). A number of studies have documented that positive remodeling lesions may be associated with unstable coronary syndromes and, therefore, may be more biologically active. In this regard, we recently reported that the preintervention pattern of remodeling is an independent predictor of clinical restenosis after non-stent coronary intervention: positive remodeling lesions had more frequent target lesion revascularization events than negative remodeling lesions. In the present study, we evaluated the interaction of baseline remodeling characteristics and clinical restenosis in native coronary lesions treated with stent implantation. It was our hypothesis that stent implantation would equalize the event rate between positive and negative remodeling lesions.