<b>Poststenting Axial Redistribution of Atherosclerotic Plaque Into the Reference Segments and Lumen Reduction at the Stent Edge</b>

Abstract

SUMMARYLumen enlargement during coronary stenting results from vessel expansion and axial redistribution of atheromatous plaque along the stented segment and proximal and distal reference segments. Plaque burden predicts stenosis at the stent edge. The aim of this study was to investigate the fate of shifted plaque with special reference to whether or not plaque shift (PSh) correlates with late lumen reduction. This is a prospective study conducted on 54 consecutive patients who underwent bare metal stenting. In all stent edges (108 edges), PSh volume was measured as postintervention plaque-media volume (PMV) minus preintervention PMV. Changes in lumen volume (∆LV), vessel volume (∆VV), and PMV (∆PMV) were measured by serial intravascular ultrasound (IVUS) examination. After stenting, PSh was detected in 81.5% of proximal edges versus 72.2% of distal edges (P = 0.36). It correlated significantly with ∆VV (r = 0.34, P = 0.002), and inversely with ∆LV (r = 0.32, P = 0.003). However, at 6-month follow-up, it did not correlate with ∆LV (r = −0.03, P = 0.8), ∆VV (r = 0.1, P = 0.6), or ∆PMV (r = 0.1, P = 0.4). Furthermore, ∆LV correlated more strongly with ∆VV (r = 0.62, P < 0.00001) than with ∆PMV (r = − 0.39, P = 0.001). By multivariate analysis, PSh area was an independent predictor of the postintervention change in lumen area (partial eta squared 0.21, P = 0.01), but not the follow-up change. Two patients (3.7%) developed proximal edge stenosis with no evident PSh after stenting. Thus, axial redistribution of atheromatous plaque into the reference segments was frequently encountered after stenting. Although PSh correlated with the immediate reduction in stent edge lumen volume, it did not correlate with the late lumen reduction. (Int Heart J 2006; 47: 159-171)

Comparative analysis of lumen enlargement mechanisms achieved with the bifurcation dedicated BiOSS® stent versus classical coronary stent implantations by means of provisional side branch stenting strategy: an intravascular ultrasound study

“…However, more detailed studies analysis have shown that the last mechanism is more complex [ 23 , 24 ]. It consists of the axial redistribution of atheromatous plaque [ 25 , 26 ] and plaque compression [ 23 ] rather than embolization [ 27 ]. Previous IVUS studies have demonstrated that in non-calcific lesions, the mechanisms of the lumen enlargement after stenting (direct implantation or after predilatation) are significantly influenced by atherosclerotic remodeling, plaque eccentricity and plaque composition [ 21 ].…”

“…In both groups, vessel and lumen areas increased equally, while the plaque area decreased after stent deployment [ 24 ]. Algowhary et al [ 25 ] showed axial redistribution of atheromatous plaque along the segment and proximal and distal reference segments. Prati et al [ 27 ] found that the decrease in the plaque area during stenting predicts CK-MB release suggesting a high association between stenting and plaque embolization in patients with unstable angina pectoris.…”

Coronary plaque redistribution after stent implantation is determined by lipid composition: A NIRS-IVUS analysis

“…Initial IVUS studies conducted in patients with SCAD demonstrated that stent implantation redistributed plaque longitudinally across the vessel to the proximal and distal edges of the stent with the potential for release of plaque debris into coronary circulation [7][8][9]. NIRS imaging alone confirmed a lipidic component of these findings [14].…”

“…NIRS-IVUS studies demonstrated that lipidrich plaques might be prone to distal embolization after stenting because of redistribution of lipidic plaque and release of its debris into circulation [7][8][9]. Indeed, stenting of lipid-rich lesions increases the risk of periprocedural myocardial infarction suggesting that plaque redistribution is related to composition and morphology [10,11].…”

Rescue Percutaneous Coronary Intervention for a Lethal "Jailed" Septal Perforator Branch to Resolve Delayed Complete Atrioventricular Block

“…Various mechanisms have been proposed, including plaque shift, the snow-plow effect, and stent jailing of the side branch. 1,12,13) An acute occlusive side branch during PCI has been shown to have a good prognosis. 14,15) The patency of the side branch is often well maintained at long-term follow-up.…”