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JCU 1994 ;2(1) :23-31.
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
Department of Internal Medicine, Wonju College of Medicine, Yonsei University, Wonju, Korea. Washington Cardiology Center, Washington D.C. USA
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±5.6㎟ in DCA v.s 15.0±2.9㎟ in ROTA, lumen CSA : 1.5±0.3㎟ in DCA v.s 1.6±0.5㎟ in ROTA, P+M CSA : 15.8±5.6㎟ in DCA v.s 13.4±3.1㎟ in ROTA). 2)Immediately after intervention, there were significant differences of EEM-CSA and lumen CSA(EEM CSA : 20.1±5.2㎟ in DCA v.s 14.9±2.2㎟ in ROTA, Lumen CSA : 6.3±1.4㎟ in DCA v.s 4.2±1.2㎟ in ROTA)(p=0.001). But, no significant difference was noted in P+M CSA between two groups(13.9±5.2㎟ v.s 10.6±1.6㎟). 3)During follow-up, there were significant differences of EEM-CSA(18.7±5.4㎟ in DCA v.s 14.8±2.3㎟ in ROTA) and P+M CSA(15.7±5.6㎟ in DCA v.s 11.8±1.9㎟ in ROTA)(p=0.008). But, no significant difference was shown in lumen CSA(2.8±1.3㎟ v.s 2.9±1.5㎟ 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.
Keywords: Intravascular ultrasound, Directional coronary atherectomy, Mechanical rotational atherectomy
Volume 25, No 4
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