Mechanism of lumen gain during coronary stentdeployment in diabetic patients compared withnon-diabetic patients

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BackgroundDiabetic patients show an increased incidence of restenosis after coronary angioplasty than non-diabetic patients. This may be because of differences in the mechanism of lumen gain during coronary revascularization in this population cohort.DesignThis study analyses the mechanism of lumen gain during coronary stent deployment in diabetic patients compared with non-diabetic patients with intravascular ultrasound (IVUS).MethodsIVUS images were obtained prior to and after revascularization in 26 diabetic and 97 non-diabetic patients. The external elastic membrane cross-sectional area (EEM) and lumen cross-sectional area (LA) were measured. Plaque area (PA) was calculated as EEM minus LA. Differences between pre- and post-LA (ΔLA), EEM (ΔEEM) and PA (ΔPA) were calculated.ResultsPre-interventional PA (diabetic patients: 12.4 ± 4.4 mm2 compared with non-diabetic patients: 10.7 ± 3.6 mm2, P = 0.04) and pre-interventional EEM (15.5 ± 4.4 mm2 compared with 13.6 ± 3.7 mm2 respectively, P = 0.02) were larger in the diabetic group. Postinterventional PA (10.2 ± 3.2 mm2 compared with 8.0 ± 3.4 mm2, P = 0.004) was also larger and postinterventional LA (6.3 ± 2.2 mm2 compared with 7.4 ± 2.4 mm2P = 0.04), ΔEEM (0.9 ± 1.8 mm2 compared with 1.8 ± 1.8 mm2P = 0.04) and ΔLA (3.1 ± 1.6 mm2 compared with 4.2 ± 2.2 mm2, P = 0.03) were smaller in the diabetic group. The diabetic group exhibited longer lesion lengths (P = 0.04) and a higher inflation pressure was used during revascularization in this patient cohort (P = 0.02).ConclusionDiabetic patients have less reduction of PA during revascularization and because the vessel wall cannot be stretched outwards despite higher inflation pressure, postinterventional LA remains smaller than in the non-diabetic population cohort. This might be a rudiment for consideration of different treatment strategies such as cutting balloon or atherectomy prior to stenting in this population group in order to achieve better procedural outcome.

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