Clinical investigations: interventional cardiologyEffect of plaque debulking before stent implantation on in-stent neointimal proliferation: A serial 3-dimensional intravascular ultrasound study
Section snippets
Study population and design
From January 2000 through January 2001, 24 patients (with 24 lesions) treated with DCA before stenting were enrolled according to these criteria: (1) successful treatment with DCA before a single Multilink stent (Guidant, Santa Clara, Calif) implantation; (2) the availability of high-quality, automated pullback IVUS images identifying lumen, stent, and media-adventitia borders throughout the length of the lesion; (3) the same arterial segments documented on serial IVUS studies (pre-procedure,
Patient characteristics
Baseline clinical and procedural characteristics are described in Table I. No statistically significant differences between the 2 groups were observed in patient characteristics and lesion characteristics, including pre-procedural QCA data.
Procedure performance
In the DCA/stenting group, the cut number was 22 ± 11, and the maximum balloon pressure during cutting was 34 ± 10 psi. Final balloon size was similar in both groups. However, the incidence of adjunctive balloon inflation was significantly higher (71% vs 17%;
Discussion
The major finding of this study was that plaque removal with DCA resulted in smaller in-stent neointimal proliferation after stent implantation than stenting performed without DCA.
Few IVUS studies, especially for 3-dimensional IVUS, are available that show the positive impact of DCA followed by stent implantation on in-stent neointimal proliferation. However, our findings are consistent with previous observations that provide indirect evidence that debulking with DCA before stenting reduces
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Cited by (9)
Coronary ischemia and percutaneous intervention
2010, Cardiovascular PathologyCitation Excerpt :The device is advanced to an area of atherosclerosis followed by shaving of the plaque with contents collected in the device nose cone [35]. The effect of an IVUS-directed and aggressive technique of DCA on the vascular endothelium was evaluated by Takeda et al. [36] using IVUS. In 24 lesions treated with DCA prior to stent placement, there was a significant decrease in the neointimal volume within the stent (i.e., in-stent neointimal volume) compared with lesions treated with stenting alone.
Coronary Interventional Devices: Balloon, Atherectomy, Thrombectomy and Distal Protection Devices
2006, Cardiology ClinicsCitation Excerpt :On the other hand, high-pressure coronary stent implantation in postmortem histopathologic studies has been shown to cause arterial medial disruption, break in internal elastic lamina, or lipid core penetration by stent struts and may induce increased arterial inflammation associated with increased neointimal growth (Fig. 1) [5]. Studies using intravascular ultrasound (IVUS) have suggested that neointimal area was predicted by the degree of underlying plaque burden (plaque area) before percutaneous coronary intervention (PCI) and the minimal lumen area achieved after PCI [6]. Prati and colleagues [7] demonstrated with IVUS analysis that late loss (degree of internal hyperplasia) has a direct correlation with the amount of residual plaque burden after stent implantation, which suggests that debulking before stenting might reduce restenosis.
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