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CLINICAL STUDIES

Serial volumetric (three-dimensional) intravascular ultrasound analysis of restenosis after directional coronary atherectomy

Evelyn A. de Vrey, MD^*, Gary S. Mintz, MD, FACC^*, Clemens von Birgelen, MD, Takeshi Kimura, MD, FACC, Masakiyo Noboyoshi, MD, FACC, Jeffrey J. Popma, MD, FACC^*, Patrick W. Serruys, MD, PhD, FACC and Martin B. Leon, MD, FACC^*

^* Intravascular Ultrasound Imaging and Cardiac Catheterization Laboratories, Washington Hospital Center, Washington, DC, USA
Kokura Memorial Hospital, Kitakyushu, Japan
Thoraxcenter, University Hospital Rotterdam Dijkzigt, The Netherlands

Manuscript received May 20, 1998; revised manuscript received July 17, 1998, accepted August 6, 1998.

Address for correspondence: Dr. Martin B. Leon, Director of Research and Education, Cardiology Research Foundation, 110 Irving Street NW, Suite 4B1, Washington, DC 20010

Objectives. We report the use of three-dimensional (volumetric) intravascular ultrasound (IVUS) analysis to assess serial changes after directional coronary atherectomy (DCA).

Background. Recent serial planar IVUS studies have described a decrease in external elastic membrane (EEM) area following catheter-based intervention as an important mechanism of late lumen renarrowing.

Methods. Thirty-one patients with de novo native coronary lesions treated with DCA in the Serial Ultrasound Restenosis (SURE) Trial and in Optimal Atherectomy Restenosis Study (OARS) were enrolled in this study. Serial IVUS was performed before and after intervention and at 6 months’ follow-up. In a subgroup of 18 patients from the SURE trial, IVUS was also performed at 24 h and at 1 month postintervention. Segments, 20-mm-long (200 image slices), were analyzed using a previously validated three-dimensional, computerized, automated edge-detection algorithm. The EEM, lumen, and plaque+media (P+M = EEM–lumen) volumes were calculated.

Results. At follow-up, lumen volume was smaller than at postintervention (159 ± 69 mm³ vs. 179 ± 49 mm³, p = 0.0003). From postintervention to follow-up, there was a decrease in EEM volume (377 ± 107 to 352 ± 125 mm³, p < 0.0001), but no change in P+M volume (p = 0.52). The lumen volume correlated strongly with EEM volume (r = 0.842, p < 0.0001), but not with P+M volume. In the 18 patients from the SURE Trial, the decrease in lumen and EEM volumes occurred late, between 1 month and 6 months of follow-up.

Conclusions. Volumetric IVUS analysis demonstrated that late lumen volume loss following DCA was a result of a decrease in EEM volume. This was a late event, occurring between 1 and 6 months’ postintervention.

Abbreviations and Acronyms   CSA = cross-sectional area   DCA = directional coronary atherectomy   DS = diameter stenosis   EEM = external elastic membrane   IVUS = intravascular ultrasound   MLD = minimum lumen diameter   P+M = plaque+media   QCA = quantitative coronary angiography

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