Get access

Volumetric intravascular ultrasound assessment of mechanisms and results of stent expansion in heart transplant patients

Authors

  • Elias A. Sanidas MD,

    1. Division of Cardiology, Center for Interventional Vascular Therapy, Columbia University Medical Center, New York, New York
    2. Cardiovascular Research Foundation, New York, New York
    Search for more papers by this author
  • Akiko Maehara MD,

    Corresponding author
    1. Cardiovascular Research Foundation, New York, New York
    • Division of Cardiology, Center for Interventional Vascular Therapy, Columbia University Medical Center, New York, New York
    Search for more papers by this author
  • Gary S. Mintz MD,

    1. Division of Cardiology, Center for Interventional Vascular Therapy, Columbia University Medical Center, New York, New York
    2. Cardiovascular Research Foundation, New York, New York
    Search for more papers by this author
  • Takashi Kubo MD,

    1. Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
    Search for more papers by this author
  • Anuj Gupta MD,

    1. School of Medicine, University of Maryland, Baltimore, Maryland
    Search for more papers by this author
  • Mark A. Apfelbaum MD,

    1. Division of Cardiology, Center for Interventional Vascular Therapy, Columbia University Medical Center, New York, New York
    2. Cardiovascular Research Foundation, New York, New York
    Search for more papers by this author
  • Diaa Hakim MD,

    1. Division of Cardiology, Center for Interventional Vascular Therapy, Columbia University Medical Center, New York, New York
    2. Cardiovascular Research Foundation, New York, New York
    Search for more papers by this author
  • Jeffrey W. Moses MD,

    1. Division of Cardiology, Center for Interventional Vascular Therapy, Columbia University Medical Center, New York, New York
    2. Cardiovascular Research Foundation, New York, New York
    Search for more papers by this author
  • Donna M. Mancini MD,

    1. Division of Cardiology, Center for Interventional Vascular Therapy, Columbia University Medical Center, New York, New York
    2. Cardiovascular Research Foundation, New York, New York
    Search for more papers by this author
  • LeRoy E. Rabbani MD

    1. Division of Cardiology, Center for Interventional Vascular Therapy, Columbia University Medical Center, New York, New York
    2. Cardiovascular Research Foundation, New York, New York
    Search for more papers by this author

  • Conflict of interest: Nothing to report.

Correspondence to: Akiko Maehara, MD, Cardiovascular Research Foundation, 111 East 59th Street, 12th floor, New York, NY 10022. E-mail: amaehara@crf.org

Abstract

Background

Percutaneous coronary intervention with stent placement for the treatment of patients with cardiac allograft vasculopathy is common, but data regarding stent behavior in this setting is lacking.

Objectives

We investigated mechanisms and potential differences in stent expansion among transplant patients vs. patients with native coronary artery atherosclerotic disease (“controls”).

Methods

We compared pre- and poststent intravascular ultrasound in 12 transplant patients (17 lesions) and 33 control patients (34 lesions) matched according to age (60.1 ± 9.2 years), diabetes mellitus, and lesion location. Planar and volumetric analysis was conducted for every 1 mm at the lesion site as well as the first 5 mm proximal and distal to the stent edge. Focal stent expansion was defined as minimum stent area (MSA) divided by mean reference lumen area. Diffuse stent expansion was defined as mean stent area divided by mean reference lumen area.

Results

Transplant patients had more plaque than “controls” prestenting, but similar MSA and focal and diffuse stent expansion afterwards. The increase in mean lumen area correlated with the increase in mean vessel area in both groups, transplant (R = 0.64, P = 0.008) and controls (R = 0.70, P < 0.0001), but correlated inversely with changes in mean plaque area only in the transplant group (R = 0.55, P = 0.027). There were no differences in calcification between the two groups and no axial plaque distribution from the lesion into the reference segments in either group.

Conclusions

The mechanism of stent expansion in transplant vasculopathy appears to be similar to de novo atherosclerosis—i.e., mainly vessel expansion to achieve similar acute results. © 2012 Wiley Periodicals, Inc.

Ancillary