Plaque Characteristics and Acute Percutaneous Coronary Intervention Outcomes According to the Remodeling Pattern in Diseased Saphenous Vein Graft: Intravascular Ultrasound Analysis
1Heart Center of Chonnam National University Hospital, Gwangju, Korea (Republic of); 2Cardiovascular Research Foundation, New York, USA; 3Chung-Ang University Hospital, Seoul, Korea (Republic of); 4Inje University Ilsan Paik Hospital, Ilsan, Korea (Republic of); 5Seoul Medical Center, Seoul, Korea (Republic of); 6Washington Hospital Center, Washington, DC, USA
Y.J. Hong1, M.H. Jeong1, Y. Ahn1, G.S. Mintz2, S.W. Kim3, S.Y. Lee4, S.Y. Kim5, A.D. Pichard6, R. Waksman6, N.J. Weissman6, J.C. Kang1
Background: Plaque characteristics and post-percutaneous coronary intervention (PCI) outcome according to the remodeling pattern in saphenous vein graft (SVG) lesions were not fully assessed. We evaluated pre- and post-PCI intravascular ultrasound (IVUS) images of 311 SVG lesions and compared IVUS findings between lesions with positive remodeling (PR, n=113) and those with intermediate/negative remodeling (IR/NR, n=198).
Methods: Remodeling index was the ratio of the lesion site SVG area to the mean of the proximal and distal references [PR: remodeling index (RI) >1.05, IR: 0.95”ĀRI”Ā1.05, NR: RI<0.95)]. Plaque prolapse (PP) was defined as tissue extrusion through the stent strut post-PCI, and the volume of PP was calculated by subtracting lumen volume from stent volume.
Results: The presence of hypoechoic plaque (59% vs. 36%, p=0.001), plaque rupture (26% vs. 16%, p=0.042), multiple plaque rupture (12% vs. 5%, p=0.020), and an intraluminal mass (59% vs. 41%, p=0.002) were more common in PR than in IR/NR lesions. Plaque cavity area was greater in PR compared with IR/NR lesions (0.83”¾1.43 mm2 vs. 0.42”¾1.07 mm2, p=0.009). Post-PCI no-reflow (19% vs. 9%, p=0.019) and post-PCI PP (53% vs. 27%, p<0.001) were more frequently observed, and PP volume were significantly greater after PCI for PR than for IR/NR lesions (0.86”¾1.30 mm3 vs. 0.34”¾0.74 mm3, p<0.001). PR was the independent predictor of post-PCI no-reflow [odds ratio (OR)=2.58; 95% CI 1.25-5.64, p=0.040] and post-stenting PP (OR=2.45; 95% CI 1.46-5.41, p=0.045).
Conclusion: SVG lesions with PR have vulnerable plaque and are associated with no-reflow and PP after PCI.
