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European Heart Journal 2004 25(22):2026-2033; doi:10.1016/j.ehj.2004.07.039
Copyright © 2004 by the European Society of Cardiology.
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Clinical research

Soft plaque detected on intravascular ultrasound is the strongest predictor of in-stent restenosis: an intravascular ultrasound study

Makoto Sahara*, Hajime Kirigaya, Yuji Oikawa, Junji Yajima, Kazuyuki Nagashima, Hitoshi Hara, Ken Ogasawara and Tadanori Aizawa

Department of Internal Medicine, The Cardiovascular Institute Hospital, 7-3-10 Roppongi, Minato-Ku, Tokyo 106-0032, Japan

Received March 24, 2004; revised June 16, 2004; accepted July 15, 2004 * Corresponding author. Present address: Department of Cardiovascular Medicine, University of Tokyo Graduate School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan. Tel.: +81 3 3408 2151/3815 5411; fax: +81 3 3814 0021 (E-mail: cfo36210{at}par.odn.ne.jp).

We state that there is neither conflict of interest nor financial disclosure to apply in this paper.

AIMS: Although various predictors of in-stent restenosis (ISR) have been reported, the subject of parameters relating to ISR on intravascular ultrasound (IVUS) still leaves room for discussion. The aim of this study was to clarify the strongest predictors of ISR using IVUS.

METHODS AND RESULTS: Ninety-two native coronary lesions undergoing single bare-metallic stent implantation were investigated retrospectively. We classified them into the ISR (n=46) and non-ISR (n=46) groups using quantitative coronary angiography. On serial IVUS studies, plaque morphology, and areas and volumes of each component in vessel were evaluated. Among all parameters, diabetes mellitus and soft plaque appearing hypoechoic on IVUS were associated with ISR. By multivariate analysis, soft plaque was the only independent predictor of ISR (p=0.0057). Compared with non-soft plaque, soft plaque had a larger plaque reduction rate (–7.1% vs. –1.6%, p=0.0613) and smaller percent plaque volume (53.0% vs. 55.5%, p=0.0273) after stenting. Conversely, soft plaque had a larger neointimal area (4.39 vs. 3.33 mm2, p=0.0437) and percent plaque area (80.5% vs. 75.1%, p=0.0503) at follow-up.

CONCLUSION: Soft plaque detected on IVUS was the strongest predictor of ISR. Soft plaque was compressed more easily by stenting, however, causing more proliferation of neointima subsequently and resulted in a worse prognosis.


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