Positive remodeling is associated with vulnerable coronary plaque components regardless of clinical presentation: Virtual histology-intravascular ultrasound analysis

Caracterização Morfológica e Tecidual de Lesões Culpadas em Pacientes com Infarto Agudo do Miocárdio com Supradesnivelamento do Segmento ST Após Uso de Fibrinolítico. Análise com Ultrassom Intracoronário e Tecnologia iMAP®

“…16,18 One of the most often studied findings associated with plaque vulnerability is arterial remodeling. Initially described by Glagov et al 19 in 1987, the positive arterial remodeling has been observed in atherosclerotic plaques responsible for acute coronary events, 6,20,21 and is associated with the increase in CK-MB after PCI, 22 no-reflow phenomena during primary PCI, 23 recurrent ischemia after PCI, 24 major cardiovascular events in patients with unstable angina undergoing any form of revascularization, 25 and intimal hyperplasia after PCI with bare-metal 26 and drug-eluting stents. 27 In the present study, the mean arterial-remodeling index was 1.4 ± 1.0, greater than 1.05, thus characterizing the predominance of positive arterial remodeling and corroborating the aforementioned literature.…”

Expansive Growth of Atherosclerotic Plaques Assessed by VH-IVUS - Association with TNF-α and OX-LDL Levels in Circulation

“…Atherosclerosis primarily affects the arterial wall and there is increasing evidence that supports the idea that positive remodelling, more than vessel stenosis, is associated to plaque vulnerability. (Hoffman et al, 2006); (Böse et al, 2007); (Napoleão et al, 2011); (Hong et al, 2012). VH-IVUS allows the observation of the vessel wall, accounting for positive remodelling, or plaque expansive growth.…”

“…There is increasing evidence suggesting the most vulnerable plaques are not associated with constrictive growth which causes vessel stenosis, but with outwards, expansive growth -positive remodelling. (Hong et al, 2012) IVUS is a widespread modality used for the direct visualization of coronary lumen, vessel wall, and atherosclerotic plaque. It allows the measurement of plaque area and any thickening of arterial walls (Amato et al, 2007); (Böse et al, 2007), which is an important advantage over coronary angiography, the golden standard method of coronary disease assessment.…”

“…Noninvasive identification of rupture-prone plaques would dramatically improve risk stratification of both symptomatic and asymptomatic patients. Therefore, associations between the expansive growth of the atherosclerotic plaque and soluble bioindicators may provide important information that enhances the precision of clinical and laboratory variables used to assess patients at risk of CAD or of plaque rupture (Ramos et al, 2013); (Hong et al, 2012).…”

Impact of Distal Protection with Filter-Type Device on Long-term Outcome after Percutaneous Coronary Intervention for Acute Myocardial Infarction: Clinical Results with Filtrap^®

“…The remodeling index was the ratio of lesion site EEM cross-sectional area divided by the average of the proximal and distal reference EEM cross-sectional areas 21, 22) .…”