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Figure 3 A serial (preintervention, postintervention, and 6-month follow-up) three-dimensional IVUS analysis is shown. Lesion length is plotted on the x-axis. The external elastic membrane (EEM) cross-sectional area over the length of the lesion is shown by the upper line, and the lumen cross-sectional area over the length of the lesion is shown by the lower line, and the plaque+media (P+M) cross-sectional area over the length of the lesion is shown by both the gray area and by the dark black line. Preintervention, the minimum lumen cross-sectional area, is at the 5-mm length marker. In this example, the increase in lumen during the directional atherectomy procedure (DCA) is almost entirely the result of a decrease in P+M cross-sectional area at the center of the lesion. At follow-up, the stenosis recurs with minimum lumen cross-sectional area again located at the 5-mm length marker. There has been a reduction in EEM cross-sectional area over the length of the lesion, but especially from the 0-mm to the 15-mm length marker. There has been no change in P+M cross-sectional area over the length of the lesion. Thus, recurrence was entirely the result of negative arterial remodeling (decrease in EEM).
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