Longitudinal plaque redistribution during stent expansion

The purpose of this study was to clarify the 3-dimensional behavior of plaque during coronary stent expansion. Serial intravascular ultrasound (IVUS) studies, preintervention, and poststenting were evaluated in 32 patients treated with a single-balloon expandable tubular stent. External elastic membrane (EEM), lumen, stent, and plaque + media cross-sectional area were measured at 1-mm intervals through the entire stent as well as proximal and distal reference segments 5 mm from the stent edge. Volumetric calculations were based on Simpson’s rule. Overall, the plaque + media volume through the entire lesion did not change during stent expansion (218 ± 51 vs 217 ± 47 mm3, p = 0.69). However, EEM and lumen volume increased significantly (EEM volume, 391 ± 84 vs 448 ± 87 mm3 [p <0.0001]; lumen volume, 173 ± 52 vs 231 ± 54 mm3 [p <0.0001]). The change in lumen volume correlated strongly with the change in EEM volume (r = 0.85, p <0.0001), but poorly with the change in plaque + media volume (r = 0.37, p = 0.03). Plaque + media volume decreased in the midstent zone (59 ± 14 vs 53 ± 11 mm3, p = 0.0005), and increased in the distal stent zone (40 ± 11 vs 44 ± 9 mm3, p = 0.003), but did not change in either the proximal stent zone or reference segments. The mechanism of stent expansion is a combination of vessel stretch and plaque redistribution, translating disease accumulation from the midstent zone to the distal stent zone.