Coronary Remodeling of Proximal and
Distal Stenotic Atherosclerotic Plaques
Within the Same Artery by Intravascular
Ultrasound Study
Toshihiko Nishioka,
MD
, Tomoo Nagai,
MD
, Huai Luo,
MD
, Katsuhiro Kitamura,
MD
,
Naohiro Hakamata,
MD
, Masahiko Akanuma,
MD
, Shuichi Katsushika,
MD
,
Akimi Uehata,
MD
, Bonpei Takase,
MD
, Kazushige Isojima,
MD
, Shingo Ohtomi,
MD
,
and Robert J. Siegel,
MD
The aim of this intravascular ultrasound study was to
compare the type and the degree of vessel remodeling in
proximal and distal de novo lesions within the same
coronary artery in patients with stable angina pectoris.
Seventy-six de novo coronary artery lesions in 38 cor-
onary arteries of 38 patients were imaged by intravas-
cular ultrasound. The vessel area (VA) within the exter-
nal elastic lamina and the lumen area (LA) were
measured, and the wall area (VA؊LA) was calculated at
the lesion site, and the proximal and distal reference
sites. The VA ratio was defined as (lesion VA/average of
the proximal and distal reference VAs) to represent the
degree of vessel remodeling. The proximal coronary
segments showed compensatory enlargement more of-
ten (68% vs 29%, p <0.01) than the distal segments,
and the VA ratio at the lesion site was significantly
larger (1.1 ؎ 0.3 vs 1.0 ؎ 0.2, p <0.01) in proximal
segments than in distal segments. The type of coronary
remodeling was discordant in 61% and concordant in
only 39% of coronary arteries between the proximal
and distal segments. The type of coronary remodeling of
proximal and distal coronary lesions was inhomoge-
neous, even within the same vessel. Proximal coronary
segments showed more prominent compensatory en-
largement than distal segments, which have a similar
degree of luminal narrowings. ᮊ2001 by Excerpta
Medica, Inc.
(Am J Cardiol 2001;87:387–391)
T
he aim of this intravascular ultrasound (IVUS)
study was to compare the degree and the type of
remodeling at proximal and distal de novo atheroscle-
rotic lesions within the same coronary artery in pa-
tients with stable angina pectoris.
METHODS
Patients, vessels, and coronary lesions studied:
For-
ty-seven patients with clinically stable angina pecto-
ris, in whom discrete de novo coronary lesions were
identified in both the proximal and distal portion of the
coronary artery by angiography as well as by IVUS,
were enrolled in this study. The proximal segment was
defined as the segment proximal to the first major
septal branch in the left anterior descending coronary
artery, the segment proximal to the first obtuse mar-
ginal branch in the left circumflex artery, and the
segment proximal to the acute marginal branch in the
right coronary artery. The distal segment was defined
as the segment distal to the landmark vessels de-
scribed above. In total, 9 vessels were excluded from
analysis because of suboptimal IVUS imaging, pres-
ence of intimal calcification (arc Ͼ60°), or lesions
with the lumen occluded (wedged) by the imaging
catheter.
Following the inclusion and exclusion criteria pre-
viously mentioned, 76 coronary lesions (38 in the
proximal and 38 in the distal segments) in 38 coronary
arteries (22 left anterior descending, 5 left circumflex,
and 11 right coronary arteries) of 38 patients (28 men
and 10 women, mean age 63 Ϯ 13 years) were in-
cluded in this study. Informed consent was obtained
from each patient before the IVUS procedure.
Intravascular ultrasound system and imaging proce-
dure:
In this study, 2 different IVUS systems were
used; one is a combination of 3.5Fr, 30-MHz short
monorail imaging catheter (Sonicath, Boston Scien-
tific Corporation, Boston, Massachusetts) and an HP
Intravascular System imaging console (M2400A,
Hewlett-Packard, Andover, Massachusetts), and the
other is a combination of 2.9Fr, 30-MHz long mono-
rail imaging catheter (MicroView, Boston, Massachu-
setts) and a CVIS imaging console (ClearView, Bos-
ton Scientific Corporation).
The imaging catheter was introduced into the target
artery through an 8Fr to 9Fr coronary guiding catheter
over a 0.014- or 0.018-inch guidewire. To prevent
possible vasospasm,
1,2
100 to 200
g of nitroglycerin
was administered directly into the coronary artery just
before IVUS imaging. After advancing the imaging
catheter across the 2 stenotic lesions to the distal
portion of the vessel under fluoroscopic guidance,
IVUS imaging was performed during the slow pull-
From the Division of Cardiology, Self Defense Forces Central Hospital,
Tokyo, Japan; and Division of Cardiology, Cedars-Sinai Medical
Center Los Angeles, California. Manuscript received June 6, 2000;
revised manuscript received and accepted August 25, 2000.
Address for reprints: Robert J. Siegel, MD, Division of Cardiology,
Room 5335, Cedars-Sinai Medical Center, 8700 Beverly Boulevard,
Los Angeles, California 90048. E-mail: siegel@cshs.edu.
387
©2001 by Excerpta Medica, Inc. All rights reserved. 0002-9149/01/$–see front matter
The American Journal of Cardiology Vol. 87 February 15, 2001 PII S0002-9149(00)01388-6