Author + information
- Received February 6, 2012
- Revision received March 26, 2012
- Accepted May 12, 2012
- Published online August 1, 2012.
- Jin Joo Park, MD⁎,
- In-Ho Chae, MD†,
- Young-Seok Cho, MD†,⁎ (, )
- Seong-Wook Kim, BS†,
- Han-Mo Yang, MD⁎,
- Jae-Bin Seo, MD‡,
- Song-Yi Kim, MD§,
- Il-Young Oh, MD†,
- Chang-Hwan Yoon, MD†,
- Jung-Won Suh, MD†,
- Kyung-Woo Park, MD⁎,
- Woo-Young Chung, MD‡,
- Tae-Jin Youn, MD†,
- Dong-Ju Choi, MD† and
- Hyo-Soo Kim, MD⁎
- ↵⁎Reprint requests and correspondence
: Dr. Young-Seok Cho, Internal Medicine, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang, Seongnam 463-707, South Korea
Objectives This study sought to investigate the extent of and factors related to lumen and vessel area change in coronary arteries after total occlusion (TO) recanalization.
Background TO of a coronary artery promotes negative remodeling in distal reference segments. Recanalization can restore blood flow, potentially leading to positive vascular remodeling.
Methods From March 2005 to June 2008, 58 consecutive patients with de novo TO lesions of at least 1-month duration were enrolled. We performed intravascular ultrasound after successful percutaneous coronary intervention and at the 6-month follow-up, and we quantified changes in the distal reference segments.
Results At the 6-month follow-up, there was a significant increase in the mean lumen diameter (+0.21 mm, p = 0.001), the mean external elastic membrane diameter (+0.13 mm, p = 0.010), the lumen area (+0.87 mm2, p < 0.001), and the external elastic membrane area (+0.85 mm2, p = 0.001) in the distal reference segments and an increase in the left ventricular ejection fraction (+2.77%, p = 0.010). Overall, 40 of 58 patients (69%) showed lumen area increase; these patients had increase in lumen diameter by 0.40 ± 0.34 mm (p < 0.001) and increase in incomplete stent apposition rate (p = 0.006). A TO duration of longer than 3 months (odds ratio [OR]: 14.8; 95% confidence interval [CI]: 1.28 to 172.8, p = 0.032), a poor collateral flow (OR: 12.0; 95% CI: 1.92 to 74.2, p = 0.008), and statin use (OR: 7.4; 95% CI: 1.03 to 53.6, p = 0.047) were independent predictors of lumen area increase.
Conclusions Recanalization of TO led to lumen area increase in two-thirds of the patients. Independent predictors of lumen area increase were occlusion duration, a poor collateral flow, and statin use. These factors could be used as guides in choosing the optimal stent size during percutaneous coronary intervention to TO lesions and optimal medical therapy during follow-up.
- collateral circulation
- coronary occlusion
- coronary vessels
- interventional ultrasonography
- myocardial revascularization
All authors have reported that they have no relationships relevant to the contents of this paper to disclose. Drs. Jin Joo Park and Chae contributed equally to this paper.
- Received February 6, 2012.
- Revision received March 26, 2012.
- Accepted May 12, 2012.
- American College of Cardiology Foundation