J Korean Soc Echocardiogr.  1994 Jul;2(1):23-31. 10.4250/jkse.1994.2.1.23.

Intravascular Ultrasonic Comparison of the Arterial Remodeling after Directional Coronary Atherectomy and Mechanical Rotational Atherectomy

• Park KS
• Yoh KG
• Cho YK
• Yoon JH
• Choe KH
• Mintz GS
• Kent KM
• Pichard AD
• Leon MB

• KMID: 2410456
• DOI: http://doi.org/10.4250/jkse.1994.2.1.23

Abstract

BACKGROUND
Directional coronary atherectomy(DCA) and mechanical rotational atherectomy(ROTA) were desinged to remove part of the obstructive tissue of atherosclerotic lesion. But, two devices have th different mechanisms of improving stenotic lesions. DCA procedure has the effects of tissue removal and some dilative effect from the large profile of the device and supporting balloon, and ROTA has the effect to increase lumen by abrading the atherosclerotic plaque into particulate debris. It is not clear at present what is more effective procedure for tissue removal, acute gain and long term results. To identify these facts, we assessed the differences of arterial and plaque remodeling between the patients treated with DCA and ROTA.
METHODS
We used a comprehensive intravascular ultrasound imaging system(25MHz rotating transducer, 3.9 Fr monorail imaging sheath, motorized transducer pullback at 0.5mm/sec, and quantification) to study 32 patients(DCA : 1 left main, 12 LAD, 2 LCX, 7 RCA and ROTA : 6 LAD, 1 LCX, 3 RCA) before, immediately after DCA and ROTA, and follow-up. Before, after DCA and ROTA, and follow-up image slices were analysed ; and the cross-sectional area(CSA) of external clastic memvrane(EEM). lumen and plaque+media(P+M) were measured.
RESULTS
1) Before intervention, there were no significant differences of EEM-CSA, lumen CSA and P+M CSA(EEN-CSA : 17.3±5.6mm2 in DCA v.s 15.0±2.9mm2 in ROTA, lumen CSA : 1.5±0.3mm2 in DCA v.s 1.6±0.5mm2 in ROTA, P+M CSA : 15.8±5.6mm2 in DCA v.s 13.4±3.1mm2 in ROTA). 2) Immediately after intervention, there were significant differences of EEM-CSA and lumen CSA(EEM CSA : 20.1±5.2mm2 in DCA v.s 14.9±2.2mm2 in ROTA, Lumen CSA : 6.3±1.4mm2 in DCA v.s 4.2±1.2mm2 in ROTA)(p=0.001). But, no significant difference was noted in P+M CSA between two groups(13.9±5.2mm2 v.s 10.6±1.6mm2). 3) During follow-up, there were significant differences of EEM-CSA(18.7±5.4mm2 in DCA v.s 14.8±2.3mm2 in ROTA) and P+M CSA(15.7±5.6mm2 in DCA v.s 11.8±1.9mm2 in ROTA)(p=0.008). But, no significant difference was shown in lumen CSA(2.8±1.3mm2 v.s 2.9±1.5mm2 in ROTA).
CONCLUSIONS
DCA is more effecitive to get the large "acute gain" than ROTA. There was no differene of luminal area between the two groups at follow-up because of larger "chronic recoil" and "intimal hyperplasia" in DCA treated patients than ROTA.

Keyword

Intravascular ultrasound; Directional coronary atherectomy; Mechanical rotational atherectomy

MeSH Terms

Atherectomy, Coronary*
Follow-Up Studies
Humans
Phenobarbital
Plaque, Atherosclerotic
Transducers
Ultrasonics*
Ultrasonography
Phenobarbital

Figure

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  Fig. 1. The intravascular ultrasound images of pre-directional coronary atherectomy(DCA)(left panel) showed the concentric tight stenotic lesion. post-DCA(middle) revealed the cutting area and dissections and follow-up(right) discovered the restenosis with fibrous plaque.

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  Fig. 2. The intravascular ultrasound images of pre-rotational coronary atherectomy(ROTA)(left panel) showed the concentric calcified stenotic lesion, post-ROTA(middle) revealed the smooth enlargement of lumen and follow-up(right) discovered the restenosis with the calcified plaque.

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  Fig. 3. The ultrasonic comparison of the plaque mass between directional atherectomy(DCA) and rotational atherectomy(ROTA) before, immediately after procedure and follow-up period.

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  Fig. 4. The changes of external elastic membrane cross-sectional area immediately after directional atherectomy(DCA) and rotational atherectomy (ROTA) compare with before procedure, and immediately after procedure with follow-up period.

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  Fig. 5. The changes of plaque mass(P+M) cross-sectional area immediately after directional atherectomy(DCA) and rotational atherectomy (ROTA) compare with before procedure, and immediately after procedure with follow-up period.

Reference

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