Premium
Mechanism of cutting balloon angioplasty for in‐stent restenosis: An intravascular ultrasound study
Author(s) -
Montorsi Piero,
Galli Stefano,
Fabbiocchi Franco,
Loaldi Alessandro,
Trabattoni Daniela,
Grancini Luca,
Cozzi Sergio,
Ravagnani Paolo,
Parodi Oberdan,
Bartorelli Antonio L.
Publication year - 2002
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.10191
Subject(s) - medicine , restenosis , intravascular ultrasound , lumen (anatomy) , stent , angioplasty , balloon , stenosis , coronary angiography , angiography , cardiology , radiology , nuclear medicine , myocardial infarction
We investigated by intravascular ultrasound (IVUS) the mechanism of action of cutting balloon (CB) angioplasty in patients with in‐stent restenosis. Seventy‐one consecutive restenotic lesions of 66 patients were studied by quantitative coronary angiography (QCA) and IVUS before, immediately after, and, in 20 cases, at 24‐hr time interval after CB. CB was selected according to 1:1 CB‐to‐stent ratio and inflated at 8 atm for 60–90 sec. Both IVUS planar and volumetric (Simpson's rule, 25 patients) analysis were carried out. IVUS measurements included external elastic membrane area (EEMA), stent area (SA), minimal lumen area (MLA), and restenosis area (RA). Following CB, QCA analysis showed increase of minimal lumen diameter (1.17 ± 0.46 vs. 2.45 ± 0.51 mm; P < 0.0001) and decrease of diameter stenosis (64% ± 13% vs. 21% ± 9%; P < 0.0001). IVUS measurements showed a significant increase of MLA (2.18 ± 0.80 vs. 7.31 ± 1.8 mm 2 ; P < 0.0001), SA (9.62 ± 2.6 vs. 10.7 ± 2.75 mm 2 ; P < 0.0001), and EEMA (17.27 ± 5 vs. 18.1 ± 5 mm 2 ; P < 0.0001) and a decrease of RA (7.43 ± 2.63 vs. 3.45 ± 1.39 mm 2 ; P < 0.0001). No significant change was observed in the original plaque + media area (7.65 ± 3 vs. 7.38 ± 2.9 mm 2 ; P = NS). Thus, of the total lumen enlargement (5.13 ± 1.85 mm 2 ), 23% was the result of increase in mean SA, whereas 77% was the result of a decrease in mean RA. These changes were associated with a 5% increase in EEMA. IVUS volumetric changes paralleled planar variations. Angiographic and IVUS changes were well maintained at 24 hr. CB enlarges coronary lumen mainly by in‐stent tissue reduction associated with a moderate degree of additional stent expansion. Favorable QCA and IVUS acute results are maintained at 24 hr. Cathet Cardiovasc Intervent 2002;56:166–173. © 2002 Wiley‐Liss, Inc.