Hyper-echoic plaque with high attenuation in intravascular ultrasound may predict slow flow during percutaneous coronary intervention.

One patient with acute inferior wall myocardial infarction underwent percutaneous coronary intervention following intravenous thrombolysis. Intravascular ultrasound (IVUS) before stenting revealed huge plaque burden with high attenuation underneath the hyper-echoic eccentric plaque surface. Stent deployment resulted in slow flow, which was managed with intra-aortic balloon counter-pulsation. His another lession in the mid left anterior descending artery showing eccentric hypo-echoic plaque with neither hyper-echoic surface nor high attenuation was successfully stented without causing slow flow.

Excessive intrastent plaque volume is the major cause of restenosis after intracoronary bare metal stent implantation: a 3-dimensional intravascular ultrasound and quantitative coronary angiography based study.

Vascular response after percutaneous coronary intervention (PCI) may differ in different ethnic group. Here we show the impact of peri-stent and intra-stent remodeling on coronary stenotic lesions in a group of Japanese patients. Those lesions were evaluated before, after and during follow up, with 3 dimensional intravascular ultrasound (IVUS) (3-D IVUS) and quantitative coronary angiography (QCA) 30 patients with pre, post and follow up IVUS were enrolled. Quantitative data are presented as the mean +/- SD, and categorical data as frequencies. Binary variables were compared with Mann Whitney's U test. There were 7 cases with restenosis (RS) and 23 cases with no-restenosis (NR). In QCA based evaluation, minimum lumen diameter (1.2 +/- 0.4 mm vs. 2.4 +/- 0.6 mm, p < 0.001) and % diameter stenosis (59.1+/- 16.1 vs. 23.3 +/- 16.1, p < 0.001) were significantly reduced in RS at follow up. Acute gain was similar among both groups (RS; 2.1 +/- 0.6 mm vs. NS; 2.2 +/- 0.7 mm, p = 0.5), however, late loss was significantly increased in RS (2.1 +/- 0.8 vs. 0.8 +/- 0.5, p < 0.001). At 3-D IVUS based follow up, lumen volume index was significantly reduced in RS (3.6 +/- 0.8 mm3/mm vs. 6.9 +/- 0.8 mm3/mm, p < 0.01). There was higher intrastent plaque volume index in RS in comparison to NR (5.4 +/- 1.4 mm3/mm vs. 3.1+/- 1.1 mm3/mm, p < 0.05). Linear regression analysis showed a tendency for a significant inverse correlation between the percentage of delta peristent volume index and the percentage of delta intrastent volume index (R2 = 0.12, p = 0.054). The intrastent plaque growth is the major player in causing restenosis.