Mechanism of cutting balloon angioplasty for in‐stent restenosis: An intravascular ultrasound study

Abstract

We investigated by intravascular ultrasound (IVUS) the mechanism of action of cutting balloon (CB) angioplasty in patients with in-stent restenosis. Seventy-one consecutive restenotic lesions of 66 patients were studied by quantitative coronary angiography (QCA) and IVUS before, immediately after, and, in 20 cases, at 24-hr time interval after CB. CB was selected according to 1:1 CB-to-stent ratio and inflated at 8 atm for 60-90 sec. Both IVUS planar and volumetric (Simpson's rule, 25 patients) analysis were carried out. IVUS measurements included external elastic membrane area (EEMA), stent area (SA), minimal lumen area (MLA), and restenosis area (RA). Following CB, QCA analysis showed increase of minimal lumen diameter (1.17 +/- 0.46 vs. 2.45 +/- 0.51 mm; P < 0.0001) and decrease of diameter stenosis (64% +/- 13% vs. 21% +/- 9%; P < 0.0001). IVUS measurements showed a significant increase of MLA (2.18 +/- 0.80 vs. 7.31 +/- 1.8 mm(2); P < 0.0001), SA (9.62 +/- 2.6 vs. 10.7 +/- 2.75 mm(2); P < 0.0001), and EEMA (17.27 +/- 5 vs. 18.1 +/- 5 mm(2); P < 0.0001) and a decrease of RA (7.43 +/- 2.63 vs. 3.45 +/- 1.39 mm(2); P < 0.0001). No significant change was observed in the original plaque + media area (7.65 +/- 3 vs. 7.38 +/- 2.9 mm(2); P = NS). Thus, of the total lumen enlargement (5.13 +/- 1.85 mm(2)), 23% was the result of increase in mean SA, whereas 77% was the result of a decrease in mean RA. These changes were associated with a 5% increase in EEMA. IVUS volumetric changes paralleled planar variations. Angiographic and IVUS changes were well maintained at 24 hr. CB enlarges coronary lumen mainly by in-stent tissue reduction associated with a moderate degree of additional stent expansion. Favorable QCA and IVUS acute results are maintained at 24 hr.

Cutting balloon angioplasty vs. conventional balloon angioplasty in patients receiving intracoronary brachytherapy for the treatment of in‐stent restenosis

“…Intravascular ultrasound analysis of mechanisms of acute lumen gain following cutting balloon angioplasty of de novo lesions suggests that cutting balloon angioplasty achieves similar postprocedural luminal gains with greater plaque reduction, less vessel expansion, and reduced early elastic recoil when compared with balloon angioplasty [12][13][14]. Similarly, cutting balloon angioplasty enlarges the coronary lumen of in-stent restenosis lesions by both in-stent tissue reduction and a moderate degree of additional stent expansion [15,16].…”

Carotid intima-media thickness by B-mode ultrasound as surrogate of coronary atherosclerosis: correlation with quantitative coronary angiography and coronary intravascular ultrasound findings

“…For each cross-sectional image, external elastic membrane crosssectional area (EEM-CSA) and the lumen CSA (L-CSA) were determined as previously reported. 34 Because calcium acoustic shadowing in the target lesion makes measurement of EEM-CSA difficult, coronary segments with .908 of circumferential calcium or 1.0 mm of axial calcium were excluded. The circumferential arc of calcium was measured using a protractor centred on the lumen; the axial length of calcium was measured by counting the number of seconds of videotape on which lesion calcium was present (2 s of videotape = 1 mm axial arterial length).…”

Brachytherapy for renal artery in‐stent restenosis

“…It was used for the initial cleavage of the neointimal hyperplasia, which was then followed by large-sized balloon inflation. CB enlarges lumen mainly by in-stent tissue reduction and some degree of additional stent expansion in coronary arteries [8]. CB use in renal arteries is limited due to larger vessel diameter and smaller balloon size.…”