Quantitative angiographic and intravascular ultrasound study >5 years after directional coronary atherectomy

Aggressive and optimal directional coronary atherectomy (DCA) using intravascular ultrasound (IVUS) guidance provides favorable outcomes within 1 year. However, no previous data are available on the changes that occur in target lesions for the long term after stand-alone DCA. This study's aim evaluates, using quantitative angiography and intravascular ultrasonography, the natural history of changes that occur in target lesions between short- (about 6 months) and long-term (>5 years) follow-up angiography after stand-alone DCA. Of 186 patients (221 lesions) with successful stand-alone DCA, 48 patients (53 lesions) underwent revascularization within 6 months, and 14 patients subsequently died, leaving a study population of 124 patients (154 lesions). Complete quantitative coronary angiography (QCA) was obtained in 91 patients (101 lesions) and complete serial IVUS assessment was obtained for 38 lesions before and after intervention and during follow-up. From short- to long-term follow-up angiography, the minimal luminal diameter significantly increased (from 2.12 to 2.56 mm; p <0.0001); lesion subgroups with >30% diameter stenosis at short-term follow-up angiography showed significant late regression as assessed by QCA. Serial IVUS assessment revealed that the vessel cross-sectional area did not change (from 17.3 to 17.4 mm(2); p = NS); however the lumen cross-sectional area significantly increased (from 7.3 to 9.5 mm(2); p <0.0001) due to the reduction of plaque plus media cross-sectional area (from 10.0 to 7.9 mm(2); p <0.0001). The change in lumen cross-sectional area correlated with the change in plaque plus media cross-sectional area (r = -0.686, p <0.0001). Target lesions show late regression due to plaque reduction at >5 years after stand-alone DCA.