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Heart 1998;79:143-147 ( February )
a Department of
Cardiology, Heart Lung Institute, University Hospital,
Utrecht, Netherlands, b Department of Cardiology, Thorax
Centre, Ignatius, Breda,
Netherlands
Correspondence to: Dr Pasterkamp, Heart Lung Institute, University Hospital Utrecht, Room G02.523, Postbox 85500, 3508 GA Utrecht, Netherlands.
Accepted for publication 22 September 1997
Objective
To assess the occurrence of arterial
remodelling types and its relation with the severity of luminal
stenosis in atherosclerotic coronary arteries.
Patients and methodsTwenty one de novo coronary
lesions of 20 patients, who were scheduled for percutaneous
transluminal coronary angioplasty (PTCA), were investigated with
intravascular ultrasound before PTCA. Local arterial remodelling at the
lesion site was studied by measuring the cross sectional area
circumscribed by the external elastic lamina (EEL) relative to the
reference site: (EEL area lesion/reference EEL area) × 100%. Three
groups were defined. Group A: relative EEL area of less than 95%
(shrinkage), group B: relative EEL area between 95% and 105% (no
remodelling), group C: relative increase in EEL area of more than 105%
(compensatory enlargement).
ResultsAll three types of remodelling were
observed at the lesion site: group A (shrinkage) n = 8, group B (no
remodelling) n = 5, group C (compensatory enlargement) n = 8. The
mean (SD) relative EEL area at the lesion site in group A and C was
83(9)% and 132(30)%, respectively. In group A, 33% of the luminal
area stenosis at the lesion site was caused by shrinkage of the artery.
In contrast, group C showed that 87% of the plaque area did not
contribute to luminal area stenosis because of compensatory arterial enlargement.
ConclusionsThese results show that both
compensatory enlargement and paradoxical shrinkage occurs in the
atherosclerotic coronary artery. Next to plaque accumulation, the type
of atherosclerotic remodelling is an important determinant of luminal narrowing.
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