Remodeling after directional coronary atherectomy (with and without adjunct percutaneous transluminal coronary angioplasty): a serial angiographic and intravascular ultrasound analysis from the optimal atherectomy restenosis study
Alexandra J. Lansky, MDa,
Gary S. Mintz, MD, FACCa,
Jeffrey J. Popma, MD, FACCa,
Augusto D. Pichard, MD, FACCa,
Kenneth M. Kent, MD, PhD, FACCa,
Lowell F. Satler, MD, FACCa,
Donald S. Baim, MD, FACCa,
Richard E. Kuntz, MD, FACCa,
Charles Simonton, MD, FACCa,
Robert M. Bersin, MD, FACCa,
Tomaki Hinohara, MD, FACCa,
Peter J. Fitzgerald, MD, PhD, FACCa and
Martin B. Leon, MD, FACCa
a Intravascular Ultrasound Imaging and Angiographic Core Laboratories, The Washington Hospital Center, Washington, DC, USA
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Figure 1 Comparison of postintervention to follow-up serial intravascular ultrasound lesion site results. Change in lumen CSA (from postintervention to follow-up) correlated with the change in EEM CSA (r = 0.790, p < 0.0001) but not with the change in P+M CSA (r = 0.133, p = 0.2258).
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Figure 2 Comparison of postintervention to follow-up serial IVUS reference segment results. Change in lumen CSA (from postintervention to follow-up) correlated with the change in EEM CSA (r = 0.781, p < 0.0001) but not with the change in P+M CSA (r = 0.155, p = 0.1627).
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Figure 3 Change in reference segment EEM CSA (from postintervention to follow-up) correlated with the change in lesion site EEM CSA (r = 0.665, p < 0.0001).
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Figure 4 Cineangiograms (center) and IVUS images from a left circumflex lesion treated with DCA and adjunct PTCA after intervention (A) and at follow-up (B). Each IVUS image is accompanied by a duplicate image that is labeled (bottom images). In each of the labeled images, the EEM is outlined in black, and the lumen is outlined in white. A, After intervention, the proximal reference EEM CSA measured 11.4 mm2, the lumen CSA measured 7.4 mm2 and the P+M CSA measured 4.0 mm2. After intervention, the lesion site EEM CSA measured 12.9 mm2, the lumen CSA measured 7.1 mm2 and the P+M CSA measured 5.6 mm2. The residual lesion site percentage of plaque area was 44%. B, at follow-up, the reference segment EEM CSA decreased to 7.0 mm2, the lumen CSA decreased to 2.5 mm2, and the P+M CSA increased to 4.5 mm2. At follow-up, the lesion site EEM CSA decreased to 6.0 mm2, the lumen CSA was assumed to be the physical size of the IVUS imaging catheter (1.0 mm2), and the P+M CSA increased to 5.0 mm2.
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