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Previous reports suggest that vessel remodeling is the most important factor in late lumen loss in non-stented lesions, but because results of directional coronary atherectomy (DCA) show that increased plaque area (PA) is also important, the aim of this study was to redefine the mechanism of late lumen loss after DCA. One hundred and twenty lesions that underwent DCA with intravascular ultrasound (IVUS) guidance and serial IVUS analysis were studied, and vessel area (VA), lumen area (LA), PA (VA-LA) and corrected values (each value divided by the value of VA pre procedure to correct the vessel size) were analyzed. During follow-up, corrected VA (cVA) decreased by 0.058 +/- 0.191, whereas corrected PA (cPA) increased by 0.087 +/- 0.159. Though the %PA (PA/VA) after the procedure showed significant negative correlation with the subsequent change in cPA, it did not correlate with the subsequent change in cVA. In conclusions, the mechanism of late lumen loss after DCA consists of both arterial remodeling and plaque proliferation, and the residual %PA after the procedure determines the subsequent lumen loss. With a lower %PA, a change in the PA contributes more to late lumen loss than do changes in VA. With a high %PA, a change in the VA contributes more to late lumen loss.

Role of Plaque Proliferation in Late Lumen Loss After Directional Coronary Atherectomy.