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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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