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Compensatory Enlargement of Angiographically Normal Coronary Segments in Patients with Coronary Artery Disease

In Vivo Documentation Using Intravascular Ultrasound

The First Department of Internal Medicine, School of Medicine, Kanazawa University, Kanazawa

Hitoshi Takemori

The First Department of Internal Medicine, School of Medicine, Kanazawa University, Kanazawa

Kouichi Shiraishi

The First Department of Internal Medicine, School of Medicine, Kanazawa University, Kanazawa

Isao Inoki

The First Department of Internal Medicine, School of Medicine, Kanazawa University, Kanazawa

Manabu Sakagami

The First Department of Internal Medicine, School of Medicine, Kanazawa University, Kanazawa

Atsuhiro Shimakura

The First Department of Internal Medicine, School of Medicine, Kanazawa University, Kanazawa

Kazuo Usuda

The First Department of Internal Medicine, School of Medicine, Kanazawa University, Kanazawa

Kouji Kubota

Department of Internal Medicine, Mattou-Ishikawa Central Hospital, Mattou, Japan

Shigeo Takata

The First Department of Internal Medicine, School of Medicine, Kanazawa University, Kanazawa

Ken-ichi Kobayashi

The First Department of Internal Medicine, School of Medicine, Kanazawa University, Kanazawa

Intravascular ultrasound (IVUS) frequently reveals plaque formation at sites with a normal angiographic appearance. However, whether angiographically normal coronary arteries undergo adaptive expansion in vivo remains uncertain. The authors studied 12 patients (11 men, 1 woman; mean age fifty-three ± ten years [mean ± SD]) with focal coronary stenosis. Sixty IVUS images from angiographically normal coronary segments were analyzed (14 left main, 44 left anterior descending, and 2 left circumflex coronary arteries). The mean percent area stenosis was 36 ± 5% and the circular shape factor of the lumen cross section averaged 0.97 ± 0.02. Both total arterial area and internal elastic lamina area increased as the plaque area expanded (y = 2.13x + 8.07, r = 0.87, P = 0.0001; y = 2.06x + 4.57, r = 0.87, P = 0.0001, respectively), suggesting that for every 1 mm2 increase in plaque area, the total arterial area increased by approximately 2.13 mm² and the internal elastic lamina area increased by approximately 2.06 mm2. The lumen area also increased as the plaque area expanded (y = 1.06x + 4.57, r = 0.68, P = 0.0001), suggesting that for every 1 mm2 increase in plaque area, the lumen area increased by approximately 1.06 mm2. The medial area did not correlate with the plaque area (r = 0.15, P = 0.26). Thus, compensatory enlargement precedes development of angiographically detectable coronary atherosclerosis. Furthermore, in early stages of atherosclerosis, arterial enlargement may overcompensate for plaque area. The reduction of the total medial mass does not appear to contribute to the mechanism of compen satory enlargement.

Angiology, Vol. 47, No. 8, 775-781 (1996)
DOI: 10.1177/000331979604700804


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