How should we define inadequate coronary arterial remodeling?

To the Editor: After our report1 showing the contribution of “inadequate compensatory enlargement” to the development of coronary narrowing, Mintz et al2 in their recently published report confirmed this concept in a larger study population by using a different definition of “inadequate arterial remodeling.” However, the assessment of the relative importance of “inadequate arterial remodeling” is highly dependent on the definition used. As pointed out by Mintz et al, the assessment of the true effect of vessel remodeling on the progression of coronary narrowing would require serial or longitudinal intravascular ultrasound studies (IVUS) over a long time period. However, such longitudinal, serial studies are time consuming and impractical. Consequently, we compared the size of the external elastic lamina (EEL) area (the area within the outer border of the sonolucent zone considered to represent EEL) at the lesion site with those at the reference sites. The proximal and distal reference sites were defined as the sites with minimal narrowing by angiography and the largest lumen area and <50% area stenosis as determined by IVUS. In our study,1 the EEL area of all arteries was larger at the proximal reference sites than at the distal reference sites, and “inadequate compensatory enlargement” was defined …