This Article Abstract Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Tsuchikane, E. Articles by Kobayashi, T. Search for Related Content PubMed PubMed Citation Articles by Tsuchikane, E. Articles by Kobayashi, T.

Final results of the STent versus directional coronary Atherectomy Randomized Trial (START)

^a Department of Cardiology, Osaka Medical Center, Osaka, Japan. There was no financial support for the study

View larger version (42K): [in a new window]   Figure 1 Difference in mechanism of lumen enlargement by stenting (n = 34) and DCA (n = 57). Both strategies provided an identical acute luminal gain by plaque reduction and vessel expansion. However, the plaque reduction ratio, which accounted for luminal gain, was significantly smaller in the stent arm (46.7% vs. 71.6%; p = 0.0014). Striped bars = plaque reduction; gray bars = vessel expansion.

View larger version (29K): [in a new window]   Figure 2 Cumulative distribution of minimal lumen diameter (MLD) (A) and diameter stenosis (B) at preprocedure (Pre), immediately after the procedure (Post) and at the six-month angiographic follow-up (F/U). Post-MLD and postdiameter stenosis were almost identical in both groups. However, the DCA arm showed larger MLD and lower diameter stenosis at F/U, with significantly lower (15.8% vs. 32.8%; p = 0.032) binary angiographic restenosis (defined as F/U diameter stenosis 50%).

View larger version (14K): [in a new window]   Figure 3 Mechanism of late lumen loss after stenting (n = 56) and DCA (n = 56) assessed by serial IVUS examination. Changes in stent CSA (+0.3 mm2) after stenting and vessel CSA (–0.4 mm2) after DCA were not remarkable. However, the increase in PA was significantly larger (3.1 vs. 1.1 mm2; p < 0.0001) in the stent arm than in the DCA arm, which accounted for the significantly larger reduction in lumen CSA (2.8 vs. 1.5 mm2; p = 0.004).

View larger version (22K): [in a new window]   Figure 4 Change in lumen CSA (from postprocedure to follow-up) correlated with the change in vessel CSA in the DCA arm group (r = 0.695, p < 0.0001). However, the change in vessel CSA was bi-directional.