Impact of attenuated-signal plaque observed by intravascular ultrasound on vessel response after drug-eluting stent implantation

Abstract Background and aims The aim of this study was to investigate the impact of attenuated-signal plaque (ASP) observed by intravascular ultrasound (IVUS) on vessel response after drug-eluting stent implantation. Methods Data were derived from the IVUS cohort of the J-DESsERT trial comparing paclitaxel- and sirolimus-eluting stents. Serial IVUS analysis (pre- and post-intervention, and 8-month follow-up) was performed in 136 non-AMI lesions. ASP was defined as hypoechoic plaque with ultrasound attenuation without calcification. Calcified plaque (CP) was defined as brightly echoreflective plaque with acoustic shadowing. ASP and CP scores were calculated by grading their measured angle as 0 to 4 for 0°, 270°, respectively. The entire stented segment was analyzed at 1-mm intervals. Results At pre-intervention, ASP was observed in 40.4% of lesions, and this group had greater % neointimal volume (%NIV) at follow-up than the no-ASP group ( p  = 0.011). ASP score at pre-intervention positively correlated with %NIV ( p  = 0.023). During the follow-up, ASP score significantly decreased ( p p p p  = 0.031), but not in SES ( p  = 0.229). Conclusions The greater extent of plaque with IVUS-signal attenuation at pre-intervention and its persistence during follow-up were associated with neointimal proliferation, possibly representing sustained inflammatory status, depending on the type of DES used.