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

Keum-Soo Park; Kyong-Gu Yoh; Yoon-Kyung Cho; Jung-Han Yoon; Kyung-Hoon Choe; Gary S Mintz; Kenneth M Kent; Augusto D Pichard; Martin B Leon

doi:10.3803/jkes.1994.2.1.23

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Park, Yoh, Cho, Yoon, Choe, Mintz, Kent, Pichard, and Leon: Intravascular Ultrasonic Comparison of the Arterial Remodeling after Directional Coronary Atherectomy and Mechanical Rotational Atherectomy

Original Article

J Korean Soc Echocardiogr 1994;2(1):23-31.

Published online: 18 February 1994

DOI: https://doi.org/10.3803/jkes.1994.2.1.23

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

Keum-Soo Park, M.D., Kyong-Gu Yoh, Yoon-Kyung Cho, M.D., Jung-Han Yoon, M.D., Kyung-Hoon Choe, M.D., Gary S Mintz, Kenneth M Kent, Augusto D Pichard, Martin B Leon

Department of Internal Medicine, Wonju College of Medicine, Yonsei University, Wonju, Korea

Washington Cardiology Center, Washington D.C. USA

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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 the 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/scc, 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 elastic membrane(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(EEM-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 effective to get the large “acute gain” than ROTA. There was no difference of luminal area between the two groups at follow-up because of larger “chronic recoil” and “intimal hyperplasia” in DCA treated patients than ROTA.

Keywords: Intravascular ultrasound, Directional coronary atherectomy, Mechanical rotational atherectomy.

References

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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.

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.

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.

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.

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.

Table 1.

Comparison of ultrasonic measurements between the directonal atherectomy and rotational atherectomy

	DCA	ROTA	P
Pre EEM CSA(mm²)	I7.3 ± 5.6	15.O± 2.9	NS
Lumen CSA(mm²)	1.5 ± 0.3	1.6 ± 0.5	NS
Arc of Calcium (⁰)	45 ± 71	65 ± 82	NS
Post FEM CSA(mm²)	20.1 ± 5.2	14.9 ± 2.2	p<0.001
Lumen CSA(mm²)	6.3 ± 1.4	4.2 ± 1.2	p = 0.001
F/U EEM CSA(mm²)	18.7 ± 5.4	14.8 ± 2.3	p= 0.008
Lumen CSA(mm²)	2.8 ± 1.3	2.9 ± 1.5	NS

^∗ DCA: directional coronary atherectomy, ROTA: mechanical rotational atherectomy, EEM: external elastic membrane, CSA: cross-sectional area, P+M: plaque + media.

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