Angiographic predictors of neointimal thickening after successful coronary wall healing following percutaneous revascularization

Abstract

This study was undertaken to characterize, by intracoronary ultrasound technique, the neointimal thickening at follow-up of treated coronary segments after successful arterial wall repair and to compare the findings with serial angiographic studies. We selected for study 81 patients with single-vessel coronary disease successfully treated by percutaneous revascularization who were angiographically and ultrasonically reevaluated at a mean follow-up time of 22 +/- 21 months; 23 had been treated by balloon angioplasty, 27 by directional atherectomy, and 31 by elective Palmaz-Schatz stent implantation. The late maximal neointimal thickness varied between 0.1 and 1.5 mm (mean 0.65 +/- 0.31 mm), and the neointimal area ranged between 0.97 and 14.9 mm(2) (mean 5.19 +/- 3.14 mm(2)). The neointimal repair was thinner in patients who obtained a better acute angiographic result immediately after treatment and in stented (3.4 +/- 1.8 mm(2)) versus dilated (7.8 +/- 4.1 mm(2)) or resected (5 +/- 1.6 mm(2), p < 0.001) segments. On the contrary, the repaired neointimal layer was thicker in those patients who angiographically exhibited less late luminal loss or even expansion and in those evaluated after a longer time since treatment. The acute gain and the time influence resulted in independent predictors of the degree of neointimal thickness. These findings suggest that two reparative mechanisms of the coronary wall may operate in close relation.