Letter to the Editor

To the Editor:Arterial remodeling (change in vessel size) is an important yet poorly understood component of coronary atherosclerotic disease: it is a stronger predictor of stenosis than plaque burden and has also been linked to plaque rupture and acute coronary syndromes.1 Extracellular matrix (ECM) protein turnover is necessary for flow-dependent physiological remodeling and postangioplasty remodeling, and recent studies have shown a correlation between de novo atherosclerotic remodeling patterns and local expression of matrix metalloproteinases (MMPs).2 However, heightened local MMP activity and ECM turnover with atherosclerotic remodeling may have other effects on the vessel. Breakdown or deficiency of elastin not only is associated with radial vessel enlargement but also leads to axial vessel enlargement and tortuosity.3 It therefore seems intuitive that tortuosity and remodeling might be interrelated: if tortuosity develops before atherosclerotic plaque build-up, then the …