Abstract
Directional coronary atherectomy (DCA) was developed to remove atheroma from eccentric lesions. Conventional teaching proposes that DCA is most effective for eccentric plaques; however, no data have correlated plaque configuration with atheroma removal. We performed intravascular ultrasound and angiography to assess the effect of plaque distribution and morphology on acute lesional success (percentage of plaque removed). We examined 101 target lesions and reference sites in 88 patients pre-and post-atherectomy. A core laboratory, blinded to outcome, classified lesions as concentric if plaque exceeded 0.75 mm in thickness for the entire 360° vessel circumference. Lesions with sparing of a portion of the vessel circumference (minimum plaque thickness < 0.75 mm) were classified as eccentric. Other variables quantified by ultrasound included the presence and arc (in degrees) of vessel wall calcification. Angiographic lesion eccentricity and/or calcification did not correlate with percentage of plaque removed. The presence of ultrasound calcium decreased the percentage of plaque removed from 24.2% to 13.6%, p = 0.05. The arc of ultrasound calcification correlated inversely with plaque removal, r = 0.55. Most importantly: Ultrasound Plaque Distribution Concentric Lesions Eccentric Lesions p value Plaque Removed (mm 2 ) 4.66 2.43 0.003 Plaque Removed (%) 29.9 18.7 0.02 Adjunctive Balloon 56% 81% 0.05 Contrary to current doctrine, atherectomy achieves better plaque removal and requires adjunctive balloon less often in lesions with concentric, rather than eccentric, atheromata. Ultrasound target lesion calcification is a negative predictor of plaque removal.
Published Version
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call