Serial volumetric (three-dimensional) intravascular ultrasound analysis of restenosis after directional coronary atherectomy

Evelyn A. De Vrey, Gary S. Mintz, Clemens Von Birgelen, Takeshi Kimura, Masakiyo Noboyoshi, Jeffrey J. Popma, Patrick W. Serruys, Martin B. Leon*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

36 Citations (Scopus)

Abstract

Objectives. We report the use of three-dimensional (volumetric) intravascular ultrasound (IVUS) analysis to assess serial changes after directional coronary atherectomy (DCA). Background. Recent serial planar IVUS studies have described a decrease in external elastic membrane (EEM) area following catheter-based intervention as an important mechanism of late lumen renarrowing. Methods. Thirty-one patients with de nero native coronary lesions treated with DCA in the Serial Ultrasound Restenosis (SURE) Trial and in Optimal Atherectomy Restenosis Study (OARS) were enrolled in this study. Serial IVUS was performed before and after intervention and at 6 months' follow-up. In a subgroup of 18 patients from the SURE trial, IVUS was also performed at 24 h and at 1 month postintervention. Segments, 20-mm-long (200 image slices), were analyzed using a previously validated three-dimensional, computerized, automated edge-detection algorithm. The EEM, lumen, and plaque+media (P+M = EEM-lumen) volumes were calculated. Results. At follow- up, lumen volume was smaller than at postintervention (159 ± 69 mm3 vs. 179 ± 49 mm3, p = 0.0003). From postintervention to follow-up, there was a decrease in EEM volume (377 ± 107 to 352 ±. 125 mm3, p < 0.0001), but no change in P+M volume (p = 0.52). The Δ lumen volume correlated strongly with ΔEEM volume (r = 0.842, p < 0.0001), but not with AP+M volume. In the 18 patients from the SURE Trial, the decrease in lumen and EEM volumes occurred late, between 1 month and 6 months of follow-up. Conclusions. Volumetric IVUS analysis demonstrated that late lumen volume loss following DCA was a result of a decrease in EEM volume. This was a late event, occurring between 1 and 6 months' postintervention.

Original languageEnglish
Pages (from-to)1874-1880
Number of pages7
JournalJournal of the American College of Cardiology
Volume32
Issue number7
DOIs
Publication statusPublished - 1 Dec 1998
Externally publishedYes

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