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Clinical, angiographic and procedural correlates of quantitative coronary dimensions after directional coronary
J J Popma1, N B De Cesare, S G Ellis
1Department of Internal Medicine (Cardiology Division), University of Michigan, Ann Arbor.
Insights
Directional coronary atherectomy significantly improves coronary artery dimensions. Factors like device size and lesion location influence outcomes, while lesion length and calcification may result in smaller final lumen areas after this cardiac intervention.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Angiography
Background:
- Directional coronary atherectomy (DCA) is a therapeutic option for coronary artery disease.
- Understanding factors influencing quantitative coronary dimensions post-DCA is crucial for optimizing patient outcomes.
Purpose of the Study:
- To identify clinical, angiographic, and procedural factors associated with quantitative coronary dimensions after DCA.
- To correlate these factors with the success and lumen dimensions achieved post-atherectomy.
Main Methods:
- Analysis of 400 lesions in 378 patients undergoing DCA.
- Utilized qualitative morphologic and quantitative angiographic methods.
- Statistical analysis included univariate and stepwise multivariate methods.
Main Results:
- Successful atherectomy achieved in 87.7% of lesions.
- Minimal cross-sectional area increased significantly (p < 0.001), and percent area stenosis decreased significantly (p < 0.001).
- Device size and left circumflex artery location correlated with larger final minimal cross-sectional area; restenotic lesions, longer lesions, and calcification correlated with smaller areas.
Conclusions:
- DCA effectively improves coronary lumen dimensions.
- Specific pre-procedural and procedural factors significantly correlate with post-DCA quantitative coronary dimensions.
- These findings aid in predicting and optimizing outcomes of directional coronary atherectomy.
Abstract:
To define the clinical, angiographic and procedural correlates of quantitative coronary dimensions after directional coronary atherectomy, 400 lesions in 378 patients were analyzed with use of qualitative morphologic and quantitative angiographic methods. Successful atherectomy, defined by a less than 75% residual area stenosis, tissue retrieval and the absence of in-hospital ischemic complications, was performed in 351 lesions (87.7%). After atherectomy, minimal cross-sectional area increased from 1.2 +/- 1.1 to 6.6 +/- 4.4 mm2 (p less than 0.001) and percent area stenosis was reduced from 87 +/- 10% to 31 +/- 42% (p less than 0.001). By univariate analysis, device size (p less than 0.001) and left circumflex artery lesion location (p = 0.004) were associated with a larger final minimal cross-sectional area. Conversely, restenotic lesion (p = 0.002), lesion length greater than or equal to 10 mm (p = 0.018) and lesion calcification (p = 0.035) were quantitatively associated with a smaller final minimum cross-sectional area. With use of stepwise multivariate analysis to control for the reference area, atherectomy device size (p = 0.003) and left circumflex lesion location (p = 0.007) were independently associated with a larger final minimal cross-sectional area, whereas restenotic lesion (p = 0.010), diffuse proximal disease (p = 0.033), lesion length greater than or equal to 10 mm (p = 0.026) and lesion calcification (p = 0.081) were significantly correlated with a smaller final minimal cross-sectional area. The number of specimens excised, the number of atherectomy passes and atherectomy balloon inflation pressure did not correlate with the final minimal cross-sectional area. Thus, directional atherectomy results in marked improvement of coronary lumen dimensions, at least in part correlated with the presence of certain clinical, angiographic and procedural factors at the time of atherectomy.