Copyright © 2003 by the European Society of Cardiology.
Eccentric atherosclerotic plaques with positive remodelling have a pericardial distribution: a permissive role of epicardial fat?
A three-dimensional intravascular ultrasound study of left anterior descending artery lesions
a San Giovanni Hospital, Rome, Italy
b Institute of Pathology, San Matteo, Pavia, Italy
c European Imaging Laboratory, European Hospital, Via Portuense 700, 00149 Rome, Italy
Received May 13, 2002;
accepted June 26, 2002
* Corresponding author. Fax: +39-06-65-38-845
f.prati{at}libero.it
Aims The transversal distribution of coronary atherosclerotic plaques (AP) (myocardial vs pericardial) affects vessel remodelling. The aim of this study was to define the impact of transversal lesion distribution on vessel remodelling in proximal and distal coronary segments using a 3D intravascular ultrasound (IVUS) reconstruction.
Methods The study group included 70 lesions located in the left anterior descending artery within 5mm of the septal take-off, and imaged using 3D-IVUS. The take-off of the septal branch was used to divide the plaque into a myocardial and pericardial surface. The IVUS index of vessel remodelling was calculated as: [narrowest external elastic membrane (EEM) site cross-sectional area (CSA)–reference EEM CSA)/reference EEM CSAx100]. The lesions with an intermediate vessel remodelling index (between –25% and +15%) were excluded from analysis.
Results Of the 38 APs with a pericardial distribution, 34 (89%) showed positive remodelling 
. The distal lesions had a positive vessel remodelling index regardless of transversal plaque distribution. At multivariate analysis, pericardial distribution and the distal location of AP were the only independent variables predictive of positive remodelling.
Conclusions The transversal distribution of atherosclerotic plaque affects vessel remodelling in left anterior descending coronary lesions, probably because of an extravascular splinting effect. Distal lesions usually show positive remodellingregardless of transversal plaque distribution.
Key Words: Arterial remodelling • Intravascular ultrasound • Coronary artery disease
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