Vascular Response after Directional Coronary Atherectomy for Left Main Bifurcation Lesion.

Norihiro Kobayashi,Takahide Nakano,Masafumi Mizusawa,Toshihiko Kishida,Shinsuke Mori,Shigemitsu Shirai,Mana Hiraishi,Kohei Yamaguchi,Kenji Makino,Jochen Wöhrle,Toshiki Chishiki,Masahiro Yamawaki,Kaori Abe,Masakazu Tsutsumi,Yohsuke Honda,Yoshiaki Ito,Tomoya Fukagawa

doi:10.1155/2021/5541843

Norihiro Kobayashi, Takahide Nakano + Show 15 more

Open Access

https://doi.org/10.1155/2021/5541843

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Abstract

Aims To evaluate the vascular response after directional coronary atherectomy (DCA) for left main (LM) bifurcation lesion. Methods This study was a retrospective, single-center study enrolling 31 patients who underwent stentless therapy using DCA followed by drug-coated balloon (DCB) angioplasty for LM bifurcation lesion. We compared intravascular ultrasound (IVUS) findings before and after DCA. Results After DCA, the lumen and vessel areas significantly increased, whereas the plaque area (PA) and %PA were significantly reduced. When the lesions were divided into small vessel and large vessel groups using the median value of the vessel area, the maximum balloon pressure of the DCA catheter was greater in the large vessel group. Changes in the lumen and vessel areas were also significantly greater in the large vessel group. On the other hand, the changes in PA and %PA were similar between groups. Conclusions The main vascular responses associated with lumen enlargement after DCA were plaque reduction and vessel expansion. Contribution of vessel expansion to lumen enlargement was larger than the effect of plaque reduction in large vessel lesions.

Highlights

Percutaneous coronary intervention (PCI) is an established option for the treatment of left main (LM) coronary artery disease [1]
Adequate lumen enlargement is important to achieve maximum efficacy of the stentless strategy using directional coronary atherectomy (DCA) followed by drugcoated balloon (DCB) angioplasty. e percentage plaque area (% PA) is a popular indicator used to determine the optimal endpoint of DCA. e main mechanism of lumen enlargement in DCA is plaque reduction [6,7,8], and increasing the balloon pressure of the DCA catheter further enhances plaque reduction [9]
Our results revealed that increasing the maximum balloon pressure of the DCA catheter in large vessel lesions was associated with greater vessel expansion but did not increase the effect on plaque reduction compared with that in small vessel lesions

Summary

Introduction

Percutaneous coronary intervention (PCI) is an established option for the treatment of left main (LM) coronary artery disease [1]. The efficacy of the stentless strategy for LM bifurcation lesions using drugcoated balloon (DCB) angioplasty after DCA was reported [5]. Adequate lumen enlargement is important to achieve maximum efficacy of the stentless strategy using DCA followed by DCB angioplasty. E main mechanism of lumen enlargement in DCA is plaque reduction [6,7,8], and increasing the balloon pressure of the DCA catheter further enhances plaque reduction [9]. Balloon angioplasty is known to induce vessel expansion which is one of the mechanisms of lumen enlargement [10, 11]. During DCA in LM bifurcation lesions, high balloon pressure of the DCA catheter is frequently required for large vessel lesions. We assessed intravascular ultrasound (IVUS) findings after DCA for LM bifurcation lesions in order to evaluate the vascular response

Materials and Methods

Results

Discussion e main findings of the current study were as follows