[Mechanism of action of directed coronary atherectomy].
The mechanism of directional coronary atherectomy (DCA) results from tissue removal and mechanical dilation ("Dotter" effect, balloon inflation). To estimate the concomitant contribution of dilation to lumen enlargement by DCA, we determined the amount of retrieved tissue and the change of luminal volume (computer-based quantitative coronary artery analysis) and compared both. The first 25 patients undergoing DCA in 1992 were enrolled in this study. In all cases DCA was successful (tissue removal, residual stenosis < 50%, absence of major complications). The diameter stenosis was reduced from 68 +/- 11% to 10 +/- 24% (p < 0.001). Calculated luminal volume increased from 1.04 +/- 0.46 mm to 2.9 +/- 0.64 (p < 0.001). The comparative value of the adjacent reference segment was a luminal diameter of 3.23 +/- 0.56 mm. The increase of the calculated luminal volume was 23 +/- 13 mm3. The average weight of removed tissue was 11 +/- 7 mg. The calculated "atherectomy index" (ratio of tissue volume retrieved to change in luminal volume) revealed a significant correlation between both volumina and averaged 0.502 for the whole group. The results show that the mechanical component plays an important part in the mechanism of luminal enlargement in addition to tissue removal and therefore could be a possible explanation for the high rate of restenosis after DCA, which was documented in the recently published big DCA trials.
Pels
K
K
Medizinische Klinik und Poliklinik B, Heinrich-Heine-Universität, Düsseldorf.
Heintzen
M P
MP
Motz
W
W
Strauer
B E
BE
D000328:Adult; D000368:Aged; D017225:Atherectomy, Coronary / Q000295:instrumentation*; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011857:Radiographic Image Interpretation, Computer-Assisted; D012008:Recurrence; D016896:Treatment Outcome
Wirkungsmechanismen der gerichteten koronaren Atherektomie (DCA).