Effects of adjunctive balloon angioplasty after intravascular ultrasound-guided optimal directional coronary atherectomy

• Published in: Journal of the American College of Cardiology Vol. 34; no. 4; pp. 1028 - 1035
• Main Authors: Suzuki, Takahiko, Hosokawa, Hiroaki, Katoh, Osamu, Fujita, Tamotsu, Ueno, Katsumi, Takase, Shinichi, Fujii, Kenshi, Tamai, Hideo, Aizawa, Tadanori, Yamaguchi, Tetsu, Kurogane, Hiroyuki, Kijima, Mikihiro, Oda, Hirotaka, Tsuchikane, Etsuo, Hinohara, Tomoaki, Fitzgerald, Peter J
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01-10-1999
• Subjects: QCU; DCA; MLD; PTCA; IVUS; QCA; DS; CAVEAT; OARS; TLR; CABG; ABACAS; BOAT
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/S0735-1097(99)00334-4

OBJECTIVES
This study was conducted to evaluate: 1) the effect of adjunctive percutaneous transluminal coronary angioplasty (PTCA) after directional coronary atherectomy (DCA) compared with stand-alone DCA, and 2) the outcome of intravascular ultrasound (IVUS)-guided aggressive DCA.
BACKGROUND
It has been shown that optimal angiographic results after coronary interventions are associated with a lower incidence of restenosis. Adjunctive PTCA after DCA improves the acute angiographic outcome; however, long-term benefits of adjunctive PTCA have not been established.
METHODS
Out of 225 patients who underwent IVUS-guided DCA, angiographically optimal debulking was achieved in 214 patients, then they were randomized to either no further treatment or to added PTCA.
RESULTS
Postprocedural quantitative angiographic analysis demonstrated an improved minimum luminal diameter (2.88 ± 0.48 vs. 2.6 ± 0.51 mm; p = 0.006) and a less residual stenosis (10.8% vs.15%; p = 0.009) in the adjunctive PTCA group. Quantitative ultrasound analysis showed a larger minimum luminal diameter (3.26 ± 0.48 vs. 3.04 ± 0.5 mm; p < 0.001) and lower residual plaque mass in the adjunctive PTCA group (42.6% vs. 45.6%; p < 0.001). Despite the improved acute findings in the adjunctive PTCA group, six-month angiographic and clinical results were not different. The restenosis rate (adjunctive PTCA 23.6%, DCA alone 19.6%; p = ns) and target lesion revascularization rate (20.6% vs. 15.2%; p = ns) did not differ between the groups.
CONCLUSIONS
With IVUS guidance, aggressive DCA can safely achieve optimal angiographic results with low residual plaque mass, and this was associated with a low restenosis rate. Although adjunctive PTCA after optimal DCA improved the acute quantitative coronary angiography and quantitative coronary ultrasonography outcomes, its benefit was not maintained at six months.