Comparison of acute elastic recoil after directional coronary atherectomy versus standard balloon angioplasty

Abstract

We evaluated intraprocedural “elastic recoil” in 25 patients (22 men and 3 women) undergoing directional coronary atherectomy (DCA) of left anterior descending stenoses, and compared these with 25 temporally-matched (14 men and 11 women) patients having balloon angioplasties (PTCA). Quantitative arteriography was performed using the Coronary Measurement System (Leiden. The Netherlands), with “elastic recoil” defined as the difference in maximum device or balloon size minus residual minimum diameter. In addition, we determined the effects of relative device size, specific anatomic location (proximal/mid artery), lesion length, eccentricity (symmetry index), and dystrophic calcification on acute “recoil” severity after both procedures. Although initial coronary stenoses were similar (minimum stenotic diameter, DCA = 0.59 ± 0.20 mm versus PTCA = 0.55 ± 0.23 mm, p =NS), less “elastic recoil” was observed after atherectomy (DCA = 0.83 ± 0.57 mm versus PTCA = 1.26 ± 0.56 mm, p < 0.01), and this was confirmed by absolute recoil/maximum device size ratios (DCA = 23.5 ± 16.0% versus PTCA = 41.6 ± 13.8%, p < 0.01). Acute “elastic recoil” was also influenced by maximum device size/“normal” coronary artery ratios [(ratio < 0.9, DCA = 0.26 ± 0.10 mm versus PTCA = 0.84 ± 0.13 mm, p < 0.01); (ratio 0.9 to 1.1, DCA = 0.69 ± 0.41 mm versus PTCA 0.75 ± 0.32 mm, p =NS); (ratio > 1.1, DCA = 1.09 ± 0.64 mm versus PTCA = 1.59 ± 0.48 mm, p < 0.05)]. Although anatomic features did not influence recoil severity after atherectomy, both lesion length (< 10 mm, 1.19 ± 0.54 mm versus > 10 mm, 1.57 ± 0.58 mm, p < 0.05) and eccentricity (symmetry index < 0.5, 1.45 ± 0.43 mm versus symmetry index > 0.5, 1.21 ± 0.59 mm, p < 0.05) adversely affected “recoil” after balloon angioplasty. Compared with standard balloon angioplasty, directional coronary atherectomy produces less “elastic recoil,” which although it is dependent on relative device size, is not influenced by stenosis morphology.