[Mechanism of action of directed coronary atherectomy]
1Medizinische Klinik und Poliklinik B, Heinrich-Heine-Universität, Düsseldorf.
Insights
Directional coronary atherectomy (DCA) enlarges lumens through tissue removal and mechanical dilation. This study found mechanical dilation significantly contributes to lumen enlargement, potentially explaining restenosis after DCA procedures.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Biomedical Engineering
Background:
- Directional coronary atherectomy (DCA) is a procedure to treat coronary artery disease.
- The mechanism of lumen enlargement in DCA involves both tissue removal and mechanical dilation.
Purpose of the Study:
- To quantify the contribution of mechanical dilation to lumen enlargement during DCA.
- To investigate the relationship between tissue removed and volume change in the coronary artery.
Main Methods:
- Quantitative coronary artery analysis was used to measure luminal volume changes.
- The weight of retrieved tissue was measured in 25 patients undergoing DCA.
- An "atherectomy index" was calculated as the ratio of retrieved tissue volume to luminal volume change.
Main Results:
- DCA significantly reduced diameter stenosis from 68% to 10%.
- Calculated luminal volume increased significantly, with mechanical dilation contributing substantially.
- The atherectomy index averaged 0.502, indicating a significant correlation between tissue removed and volume increase.
Conclusions:
- Mechanical dilation plays a significant role in lumen enlargement during DCA, alongside tissue removal.
- This mechanical component may contribute to the high rates of restenosis observed after DCA.
Abstract:
The mechanism of directional coronary atherectomy (DCA) results from tissue removal and mechanical dilation ("Dotter" effect, balloon inflation). To estimate the concomitant contribution of dilation to lumen enlargement by DCA, we determined the amount of retrieved tissue and the change of luminal volume (computer-based quantitative coronary artery analysis) and compared both. The first 25 patients undergoing DCA in 1992 were enrolled in this study. In all cases DCA was successful (tissue removal, residual stenosis < 50%, absence of major complications). The diameter stenosis was reduced from 68 +/- 11% to 10 +/- 24% (p < 0.001). Calculated luminal volume increased from 1.04 +/- 0.46 mm to 2.9 +/- 0.64 (p < 0.001). The comparative value of the adjacent reference segment was a luminal diameter of 3.23 +/- 0.56 mm. The increase of the calculated luminal volume was 23 +/- 13 mm3. The average weight of removed tissue was 11 +/- 7 mg. The calculated "atherectomy index" (ratio of tissue volume retrieved to change in luminal volume) revealed a significant correlation between both volumina and averaged 0.502 for the whole group. The results show that the mechanical component plays an important part in the mechanism of luminal enlargement in addition to tissue removal and therefore could be a possible explanation for the high rate of restenosis after DCA, which was documented in the recently published big DCA trials.
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