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J Am Coll Cardiol, 1999; 34:33-39
© 1999 by the American College of Cardiology Foundation
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Mechanisms of acute lumen gain and recurrent restenosis after rotational atherectomy of diffuse in-stent restenosis

A quantitative angiographic and intravascular ultrasound study

Peter W. Radke, MDa, Heinrich G. Klues, MD, FESCa, Philipp K. Haager, MDa, Rainer Hoffmann, MD, FESCa, Frank Kastrau, MSa, Thorsten Reffelmann, MDa, Uwe Janssens, MDa, Juergen vom Dahl, MD, FESCa and Peter Hanrath, MD, FESC, FACCa

a Medical Clinic I, RWTH University Hospital, Aachen, Germany



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  		Figure 1 Comparison of minimal lumen diameter measurements obtained by intravascular ultrasound (IVUS) and quantitative coronary angiography (QCA) before intervention (A), after rotational atherectomy (B) and after percutaneous transluminal coronary angioplasty (PTCA) (C) using the Bland-Altman method. The individual differences between pairs of measurements (on the y-axis) are plotted against the mean value of IVUS and QCA (on the x-axis). CI = confidence interval.

 


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  		Figure 2 Relation between in-stent neointima distribution and focal plaque ablation. Due to inhomogeneous plaque distribution and focal neointima accumulation (1A, 1B) the minimal lumen diameter before rotablation ranges between 0.9 mm (1D) and 2.4 mm (1C) by intravascular ultrasound. Rotational atherectomy (burr size 2.38 mm) does not induce further plaque ablation in those parts of the stent with a larger lumen (2A, 2C), even though there is significant plaque burden. Focal plaque ablation (2B) leads to an increase in the minimal lumen diameter and cross-sectional area as shown by intravascular ultrasound (2D); however, the final burr/lumen ratio >1 indicates acute neointimal recoil.

 




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