Effect of preinterventional arterial remodeling on intimal hyperplasia after implantation of a polymer-based paclitaxel-eluting stent: angiographic and IVUS study.

Background: The aim of this study was to evaluate the effect of preinterventional arterial remodeling on in-stent intimal hyperplasia (IH) after the implantation of a polymer-based paclitaxel-eluting stent.

Methods: The study population consisted of 55 patients (61 lesions) with a de novo lesion treated with a paclitaxel-eluting stent. The lesions were divided into two groups, positive or intermediate (PR/IR), and negative remodeling (NR) groups, according to the preinterventional arterial remodeling. Angiographic and IVUS examinations were performed preintervention, postintervention and at 9 months of follow-up.

Results: The remodeling index (RI) was 1.19+/-0.16 in the PR/IR group and 0.81+/-0.10 in the NR group. At follow-up, the late loss was significantly larger in the PR/IR group than in the IR group. (0.65+/-0.58 mm vs. 0.29+/-0.5 mm, p=0.017). The external elastic membrane cross-sectional area (CSA) (18.68+/-5.39 vs. 12.87+/-3.72 mm(2), p=0.000), plaque CSA (16.99+/-4.04 vs. 10.34+/-3.45 Mm(2), p=0.000) and plaque index (85.84+/-5.02 vs. 81.80+/-7.26%, p=0.048) during the preintervention period and IH volume during the follow-up were significantly larger in the PR/IR group than in the NR group (17.98+/-16.7 mm(3) vs. 4.59+/-12.4 mm(3); p<0.001). Further, the percentage of the change in the IH was also larger in the PR/IR group than in the NR group (13.49+/-11.78% vs. 4.12+/-10.76%; p=0.002). A significant positive correlation was found between the preinterventional RI and follow-up IH CSA (r=0.406, p=0.001).

Conclusions: The preinterventional arterial remodeling influenced the development of the IH after the implantation of the polymer-based paclitaxel-eluting stent which had a greater effect on reducing the IH accumulation in the lesions with preinterventional negative remodeling characteristics.