Serial volumetric (three-dimensional) intravascular ultrasound analysis of restenosis after directional coronary atherectomy
Related Experiment Video
Updated: Oct 26, 2026
Intravascular Ultrasound Image-Based Finite Element Modeling Approach for Quantifying In Vivo Mechanical Properties of Human Coronary Artery
Published on: December 6, 2024
E A de Vrey1, G S Mintz, C von Birgelen
1Intravascular Ultrasound Imaging Laboratory, Washington Hospital Center, Washington, DC, USA.
Insights
Three-dimensional intravascular ultrasound (IVUS) reveals that late lumen volume loss after directional coronary atherectomy (DCA) is due to a decrease in external elastic membrane (EEM) volume. This occurs between 1 and 6 months post-procedure.
Area of Science:
- Cardiovascular imaging
- Interventional cardiology
- Medical device technology
Background:
- Serial planar intravascular ultrasound (IVUS) studies indicate reduced external elastic membrane (EEM) area post-intervention contributes to late lumen renarrowing.
- Understanding mechanisms of lumen renarrowing is crucial for optimizing interventional cardiology outcomes.
Purpose of the Study:
- To evaluate serial changes in coronary vessel volumes using three-dimensional (volumetric) IVUS after directional coronary atherectomy (DCA).
- To determine the specific volumetric changes contributing to late lumen loss following DCA.
Main Methods:
- Thirty-one patients undergoing DCA for native coronary lesions were analyzed using serial volumetric IVUS (pre-intervention, post-intervention, 6-month follow-up).
- A subgroup of 18 patients had additional IVUS imaging at 24 hours and 1 month.
- A validated 3D automated edge-detection algorithm calculated external elastic membrane (EEM), lumen, and plaque+media (P+M) volumes.
Main Results:
- A significant decrease in lumen volume was observed from post-intervention to 6-month follow-up (179 ± 49 mm³ to 159 ± 69 mm³, p=0.0003).
- External elastic membrane (EEM) volume decreased significantly from post-intervention to follow-up (377 ± 107 mm³ to 352 ± 125 mm³, p<0.0001), while plaque+media (P+M) volume remained unchanged (p=0.52).
- The reduction in lumen volume strongly correlated with the decrease in EEM volume (r=0.842, p<0.0001).
Conclusions:
- Volumetric IVUS analysis confirms that late lumen volume loss after DCA is primarily attributed to a reduction in EEM volume.
- This EEM volume reduction is a late phenomenon, occurring predominantly between 1 and 6 months post-DCA.
Objectives:
We report the use of three-dimensional (volumetric) intravascular ultrasound (IVUS) analysis to assess serial changes after directional coronary atherectomy (DCA).
Background:
Recent serial planar IVUS studies have described a decrease in external elastic membrane (EEM) area following catheter-based intervention as an important mechanism of late lumen renarrowing.
Methods:
Thirty-one patients with de novo native coronary lesions treated with DCA in the Serial Ultrasound Restenosis (SURE) Trial and in Optimal Atherectomy Restenosis Study (OARS) were enrolled in this study. Serial IVUS was performed before and after intervention and at 6 months' follow-up. In a subgroup of 18 patients from the SURE trial, IVUS was also performed at 24 h and at 1 month postintervention. Segments, 20-mm-long (200 image slices), were analyzed using a previously validated three-dimensional, computerized, automated edge-detection algorithm. The EEM, lumen, and plaque+media (P+M = EEM-lumen) volumes were calculated.
Results:
At follow-up, lumen volume was smaller than at postintervention (159+/-69 mm3 vs. 179+/-49 mm3, p = 0.0003). From postintervention to follow-up, there was a decrease in EEM volume (377+/-107 to 352+/-125 mm3, p < 0.0001), but no change in P+M volume (p = 0.52). The delta lumen volume correlated strongly with deltaEEM volume (r = 0.842, p < 0.0001), but not with deltaP+M volume. In the 18 patients from the SURE Trial, the decrease in lumen and EEM volumes occurred late, between 1 month and 6 months of follow-up.
Conclusions:
Volumetric IVUS analysis demonstrated that late lumen volume loss following DCA was a result of a decrease in EEM volume. This was a late event, occurring between 1 and 6 months' postintervention.