Effect of plaque debulking before stent implantation on in-stent neointimal proliferation: a serial 3-dimensional intravascular ultrasound study.
BACKGROUND
Recent intravascular ultrasound (IVUS) studies have suggested that plaque burden has a role in promoting intimal hyperplasia after stenting. We report on volumetric assessments of in-stent neointimal formation with 3-dimensional IVUS analysis, comparing directional coronary atherectomy (DCA) plus stenting (DCA/stenting) to stenting without DCA.


METHODS
Twenty-four patients (24 lesions) treated with DCA before stenting were matched to 24 patients (24 lesions) receiving stenting without DCA. All stents were a single Multilink stent. In both groups, serial IVUS was performed before and after intervention and during the 6-month follow-up period. The arterial segments that were analyzed with a computer-based contour detection program were the same as the stented segments analyzed on serial studies. These measurements were obtained: (1) lumen volume (LV), (2) stent volume (SV), (3) vessel volume (VV), (4) in-stent neointimal volume (ISV) calculated as SV-LV, and (5) percent in-stent neointimal volume (%ISV) calculated as ([SV-LV]/SV) x 100.


RESULTS
Baseline characteristics of the 2 groups were similar. After intervention, both groups achieved similar LV (140.0 mm(3) DCA/stenting vs 135.2 mm(3) stenting alone). However, the follow-up ISV and %ISV were significantly smaller in the DCA/stenting group (19.6 +/- 12.2 mm(3) DCA/stenting vs 44.6 +/- 29.5 mm(3) stenting alone; P =.00040; 15.3% +/- 10.6% DCA/stenting vs 31.5% +/- 17.7% stenting alone; P =.00040). Consequently, the DCA/stenting group showed a significantly greater follow-up LV (121.0 +/- 51.5 mm(3) DCA/stenting vs 91.5 +/- 26.7 mm(3) stenting alone; P =.016).


CONCLUSIONS
Plaque removal with DCA before stenting inhibits in-stent neointimal hyperplasia.
Takeda
Yoshihiro
Y
Department of Cardiology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka City, Japan. takeda@xk9.so-net.ne.jp
Tsuchikane
Etsuo
E
Kobayashi
Tomoko
T
Terai
Kazuo
K
Kobayashi
Yoshiki
Y
Nakagawa
Tsutomu
T
Sakurai
Makoto
M
Awata
Nobuhisa
N
Kobayashi
Tohru
T
D000368:Aged; D017225:Atherectomy, Coronary; D003131:Combined Modality Therapy; D003324:Coronary Artery Disease / Q000601:surgery / Q000628:therapy*; D023903:Coronary Restenosis / Q000517:prevention & control; D019160:Endosonography / Q000379:methods*; D005260:Female; D006801:Humans; D006965:Hyperplasia / Q000517:prevention & control; D021621:Imaging, Three-Dimensional; D008297:Male; D015607:Stents; D017539:Tunica Intima / Q000473:pathology*; D018084:Ultrasonography, Interventional