Impact of attenuated-signal plaque observed by intravascular ultrasound on vessel response after drug-eluting stent implantation. (April 2017)

• Record Type: Journal Article
• Authors: Kitahara, Hideki; Waseda, Katsuhisa; Sakamoto, Kenji; Yamada, Ryotaro; Huang, Ching-Chang; Nakatani, Daisaku; Sakata, Kenji; Kawarada, Osami; Yock, Paul G.; Matsuyama, Yutaka; Yokoi, Hiroyoshi; Nakamura, Masato; Muramatsu, Toshiya; Nanto, Shinsuke; Fitzgerald, Peter J.; Honda, Yasuhiro
• Is Part Of: Atherosclerosis. Volume 259(2017)
• Page Start: 68
• Page End: 74
• Publication Date: 2017-04
• Subjects: Drug-eluting stent -- Intravascular ultrasound -- Attenuation; Arteriosclerosis -- Periodicals; Electronic journals; 616.136
• DOI: 10.1016/j.atherosclerosis.2017.02.009
• Languages: English
• ISSNs: 0021-9150

Abstract

Abstract: Background and aims: The aim of this study was to investigate the impact of attenuated-signal plaque (ASP) observed by intravascular ultrasound (IVUS) on vessel response after drug-eluting stent implantation. Methods: Data were derived from the IVUS cohort of the J-DESsERT trial comparing paclitaxel- and sirolimus-eluting stents. Serial IVUS analysis (pre- and post-intervention, and 8-month follow-up) was performed in 136 non-AMI lesions. ASP was defined as hypoechoic plaque with ultrasound attenuation without calcification. Calcified plaque (CP) was defined as brightly echoreflective plaque with acoustic shadowing. ASP and CP scores were calculated by grading their measured angle as 0 to 4 for 0°, <90°, 90–180°, 180–270° and >270°, respectively. The entire stented segment was analyzed at 1-mm intervals. Results: At pre-intervention, ASP was observed in 40.4% of lesions, and this group had greater % neointimal volume (%NIV) at follow-up than the no-ASP group ( p = 0.011). ASP score at pre-intervention positively correlated with %NIV ( p = 0.023). During the follow-up, ASP score significantly decreased ( p < 0.001), and CP score significantly increased ( p < 0.001), with a negative correlation between them ( p < 0.001). A decrease in the ASP score was associated with less %NIV in PES ( p = 0.031), but not in SES ( p = 0.229). Conclusions: The greater extent of plaque with IVUS-signal attenuation at pre-intervention and its persistence during follow-up were associated with neointimal proliferation, possibly representing sustained inflammatory status, depending on the type of DES used. Highlights: Presence and extent of attenuated-signal plaque (ASP) correlated with neointimal hyperplasia after DES implantation. Decrease in ASP was accompanied by proportional increase in calcification. Decrease in ASP was associated with reduced neointimal hyperplasia within the stent. Persistence of ASP may indicate sustained inflammatory status. Transformation of ASP to calcified plaque may represent the process of plaque stabilization.