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CLINICAL STUDIES

Effects of adjunctive balloon angioplasty after intravascular ultrasound-guided optimal directional coronary atherectomy

The result of adjunctive balloon angioplasty after coronary atherectomy study (ABACAS)

Takahiko Suzuki, MD^*, Hiroaki Hosokawa, MD, Osamu Katoh, MD, Tamotsu Fujita, MD, Katsumi Ueno, MD^||, Shinichi Takase, MD^¶, Kenshi Fujii, MD^#, Hideo Tamai, MD^**, Tadanori Aizawa, MD, Tetsu Yamaguchi, MD, PhD, Hiroyuki Kurogane, MD, Mikihiro Kijima, MD^||||, Hirotaka Oda, MD^¶¶, Etsuo Tsuchikane, MD^##, Tomoaki Hinohara, MD, FACC^***, Peter J. Fitzgerald, MD, PhD, FACC for the ABACAS Investigators

^* Division of Cardiology, Toyohashi Heart Center, Aichi, Japan
National Toyohashi Higashi Hospital, Aichi, Japan
Kyoto Katsura Hospital, Kyoto, Japan
Okamura Kinen Hospital, Shizuoka, Japan
^|| Gifu Municipal Hospital, Gifu, Japan
^¶ Takase Clinic, Gumma, Japan
^# Sakurabashi Watanabe Hospital, Osaka, Japan
^** Shiga Medical Center, Shiga, Japan
Cardiovascular Institute, Tokyo, Japan
Toho University Ohashi Hospital, Tokyo, Japan
Himeji Cardiovascular Center, Hyogo, Japan
^|||| Hoshi Sogo Hospital, Fukushima, Japan
^¶¶ Niigata City General Hospital, Niigata, Japan
^## The Center for Adult Diseases Osaka, Osaka, Japan;
^*** Sequoia Hospital, Redwood City, California, USA
Stanford University, Stanford, California; USA

Manuscript received December 31, 1998; revised manuscript received May 12, 1999, accepted June 25, 1999.

Reprint requests and correspondence: Dr. Takahiko Suzuki, Toyohashi Heart Center, 21 Aza-Gobutori, Ohyama-cho, Toyhashi, Aichi 441-8071, Japan

OBJECTIVES

This study was conducted to evaluate: 1) the effect of adjunctive percutaneous transluminal coronary angioplasty (PTCA) after directional coronary atherectomy (DCA) compared with stand-alone DCA, and 2) the outcome of intravascular ultrasound (IVUS)-guided aggressive DCA.

BACKGROUND

It has been shown that optimal angiographic results after coronary interventions are associated with a lower incidence of restenosis. Adjunctive PTCA after DCA improves the acute angiographic outcome; however, long-term benefits of adjunctive PTCA have not been established.

METHODS

Out of 225 patients who underwent IVUS-guided DCA, angiographically optimal debulking was achieved in 214 patients, then they were randomized to either no further treatment or to added PTCA.

RESULTS

Postprocedural quantitative angiographic analysis demonstrated an improved minimum luminal diameter (2.88 ± 0.48 vs. 2.6 ± 0.51 mm; p = 0.006) and a less residual stenosis (10.8% vs.15%; p = 0.009) in the adjunctive PTCA group. Quantitative ultrasound analysis showed a larger minimum luminal diameter (3.26 ± 0.48 vs. 3.04 ± 0.5 mm; p < 0.001) and lower residual plaque mass in the adjunctive PTCA group (42.6% vs. 45.6%; p < 0.001). Despite the improved acute findings in the adjunctive PTCA group, six-month angiographic and clinical results were not different. The restenosis rate (adjunctive PTCA 23.6%, DCA alone 19.6%; p = ns) and target lesion revascularization rate (20.6% vs. 15.2%; p = ns) did not differ between the groups.

CONCLUSIONS

With IVUS guidance, aggressive DCA can safely achieve optimal angiographic results with low residual plaque mass, and this was associated with a low restenosis rate. Although adjunctive PTCA after optimal DCA improved the acute quantitative coronary angiography and quantitative coronary ultrasonography outcomes, its benefit was not maintained at six months.

Abbreviations and Acronyms   ABACAS = Adjunctive Balloon Angioplasty After Coronary Atherectomy Study   BOAT = Balloon Versus Optimal Atherectomy Trial   CABG = coronary artery bypass graft   CAVEAT = Coronary Angioplasty Versus Excisional Atherectomy Trial   DCA = directional coronary atherectomy   DS = diameter stenosis   IVUS = intravascular ultrasound   MLD = minimum lumen diameter   OARS = Optimal Atherectomy Restenosis Study   PTCA = percutaneous transluminal coronary angioplasty   QCA = quantitative coronary angiography   QCU = quantitative coronary ultrasonography   TLR = target lesion revascularization

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