Intracoronary ultrasound assessment of directional coronary atherectomy: immediate and follow-up findings

Hospital Reina Sofia, University of Cordoba, Spain.

OBJECTIVES. This study was conducted to assess the relations among intracoronary ultrasound, angiographic and histologic data obtained from patients with coronary artery disease successfully treated by directional coronary atherectomy. In addition, it was designed to elucidate whether some aspects of intravascular ultrasound or pathologic findings could predict a propensity to restenosis. BACKGROUND. Intracoronary ultrasound is a useful technique in guiding and assessing atherectomy. However, there is little information about the characterization of the different types of coronary plaques and the changes observed in them after resection. Furthermore, the follow-up ultrasound appearance of previously treated lesions remains undepicted. METHODS. Fifty-two patients (54 +/- 10 years old) were studied. All were successfully treated by atherectomy with the aid of intracoronary ultrasound guidance. Qualitative and quantitative ultrasound and angiographic variables were derived before and after resection. Quantitative histologic morphometric information was also obtained from the specimens. In 22 patients, a follow-up echoangiographic reevaluation was performed 6 +/- 4 months later. RESULTS. Echogenic plaques had a higher collagen and calcium content, whereas echolucent plaques had an increased level of fibrin, nuclei and lipids. Ultrasound plaque reduction after atherectomy was greater in echolucent (76 +/- 21%) than in echogenic plaques (60 +/- 18%; p < 0.05). That reduction correlated with the weight of the resected material (r = 0.62; p < 0.01). At follow-up study, 13 of 22 patients had angiographic and ultrasound evidence of restenosis. Most recurrent lesions had a stenotic three-layer appearance. The incidence of restenosis of primary lesions treated with atherectomy was higher in echolucent (100%) than in echogenic (33%) plaques. Similarly, a higher proportion of nuclear content in the resected material was observed in patients who developed restenosis (2.1 +/- 0.7%) than in patients who had late success after atherectomy (1.2 +/- 0.6%). CONCLUSIONS. Our findings suggest that echolucent plaques are easier to resect than are echogenic plaques but frequently develop restenosis. In contrast, the resection of echogenic plaques, although often incomplete, is associated with better long-term results.

This article has been cited by other articles:

				J. L. Orford, A. Lerman, and D. R. Holmes Routine intravascular ultrasound guidance of percutaneous coronary intervention: A critical reappraisal J. Am. Coll. Cardiol., April 21, 2004; 43(8): 1335 - 1342. [Abstract] [Full Text] [PDF]

				M. Nakamura, H. Nishikawa, S. Mukai, M. Setsuda, K. Nakajima, H. Tamada, H. Suzuki, T. Ohnishi, Y. Kakuta, T. Nakano, et al. Impact of coronary artery remodeling on clinical presentation of coronary artery disease: an intravascular ultrasound study J. Am. Coll. Cardiol., January 1, 2001; 37(1): 63 - 69. [Abstract] [Full Text] [PDF]

				C von Birgelen, G S Mintz, E A de Vrey, P W Serruys, T Kimura, M Nobuyoshi, J J Popma, M B Leon, R Erbel, and P J de Feyter Preintervention lesion remodelling affects operative mechanisms of balloon optimised directional coronary atherectomy procedures: a volumetric study with three dimensional intravascular ultrasound Heart, February 1, 2000; 83(2): 192 - 197. [Abstract] [Full Text]

				P. J. Scanlon, D. P. Faxon, A.-M. Audet, B. Carabello, G. J. Dehmer, K. A. Eagle, R. D. Legako, D. F. Leon, J. A. Murray, S. E. Nissen, et al. ACC/AHA guidelines for coronary angiography: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Coronary Angiography) developed in collaboration with the Society for Cardiac Angiography and Interventions J. Am. Coll. Cardiol., May 1, 1999; 33(6): 1756 - 1824. [Full Text] [PDF]

				N. D. Wong, R. C. Detrano, D. Abrahamson, J. M. Tobis, and J. M. Gardin Coronary Artery Screening by Electron Beam Computed Tomography : Facts, Controversy, and Future Circulation, August 1, 1995; 92(3): 632 - 636. [Full Text]