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This subanalysis aims to explore Glagovian artery remodeling.
The artery remodeling in patients of NANOM-FIM trial (NCT01270139) was examined at the baseline and at 12-month follow-up (n=180) with 40 MHz intravascular ultrasound (IVUS).
The polynomial regression analysis of a degree of six (R2=0.774) of IVUS confirmed existence of a window of the external elastic membrane (EEM) enlargement between 21% and 44% of per cent atheroma volume (PAV) in patients with a 30.7% decrease of PAV at 12-month follow-up. Patients with PAV below 21% have significant positive correlation between volumes of EEM, plaque and media which means naïve lumen. The trend between 21% and 34% is essentially the true Glagov phenomenon without lumen loss. The strength of that correlation was lost when PAV increased beyond 44% due to functional exhaustion of the compensatory EEM enlargement. The slowdown of the lumen narrowing in lesions with PAV above 63% documents advanced fibroatheromas with calcification. The serial assessments of IVUS showed a significant decrease at 12 months in the dense calcium area and fibro-fatty tissue in nano groups with an increase in necrotic core post-procedure and further reduction in size at 12 months (p<0.05).
The PAV below 40-44% (a window of EEM enlargement of 21-44% PAV) after intervention guarantees restoration of the artery geometry with significant decline in clinical outcomes, which might become the optimal target for atheroregression strategies.