Stenting after directional coronary atherectomy compared with directional coronary atherectomy alone and stenting alone: a serial intravascular ultrasound study.
BACKGROUND
Directional coronary atherectomy prior to stent implantation (DCA-stent) is expected to be an effective approach to reduce restenosis. The purpose of this study was to determine whether DCA-stent has advantages over DCA alone or stenting alone using serial intravascular ultrasound (IVUS).


RESULTS
Serial (pre-, post- and follow-up) IVUS was performed in 187 native coronary lesions treated with each of the 3 strategies. External elastic membrane cross-sectional area (CSA), lumen CSA and plaque CSA were measured. Baseline characteristics were similar. Postprocedural lumen CSA was largest after DCA-stent (11.2+/-2.7 mm2) and DCA (10.8+/-2.5 mm2) than stenting alone (9.0+/-2.9 mm2) (p<0.0005). Follow-up lumen loss was similar. As a result, follow-up lumen CSA was largest after DCA-stent (DCA-stent: 9.1+/-3.4 mm2, DCA: 7.8+/-4.2 mm2, stent: 6.3+/-2.6 mm2, p<0.0005). There was a trend toward a lower rate of restenosis with DCA-stent (DCA-stent, 12.5%; DCA, 18.3%; stent, 18.8%; p=0.57).


CONCLUSIONS
DCA-stent is superior to both DCA alone and stent alone in terms of the ability to gain a larger lumen as assessed by IVUS.
Kawamura
Akio
A
Cardiopulmonary Division, Department of Medicine, Keio University School of Medicine, Tokyo, Japan. akiok@wg8.so-net.ne.jp
Asakura
Yasushi
Y
Ishikawa
Shiro
S
Okabe
Teruo
T
Yamane
Akiko
A
Li
Hui-Chong
HC
Ogawa
Satoshi
S
D000368:Aged; D017225:Atherectomy, Coronary / Q000592:standards*; D017023:Coronary Angiography; D003327:Coronary Disease / Q000000981:diagnostic imaging* / Q000601:surgery*; D023903:Coronary Restenosis / Q000000981:diagnostic imaging / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents / Q000592:standards*; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional