Three-dimensional intravascular ultrasound assessment of plaque volume after successful atherectomy

The primary purpose of directional coronary atherectomy is the removal of intraluminal plaque. Angiography allows assessment of residual lumen narrowing but is limited in the assessment of residual plaque burden. Intravascular ultrasound has proven useful in assessing plaque size, but current use has been limited to a single, representative cross-sectional image rather than an evaluation of the entire plaque volume. To determine the volume of residual plaque after angiographically successful directional coronary atherectomy ( < or = 20% residual stenosis), we performed intravascular ultrasound in 19 patients before and after atherectomy. Only coronary lesions optimal for three-dimensional analysis (a single, discrete stenosis in a nontortuous, noncalcified native coronary artery) were selected. A 2.9F sheath-design intravascular ultrasound catheter with a motorized pullback device was used in all patients. The cross-sectional area of the artery (defined by the medial-adventitia border), the lumen, and the plaque were measured at 1 mm intervals over a 15 to 20 mm segment, which included the target lesion and a proximal reference segment (n = 362 cross-sections), before and after atherectomy. The volumes of the artery, vessel lumen, or plaque were calculated with a modified Simpson's equation and compared with standard area measurements at the point of maximal stenosis.(ABSTRACT TRUNCATED AT 250 WORDS)