Vascular Response after Directional Coronary Atherectomy for Left Main Bifurcation Lesion

Abstract

Aims. To evaluate the vascular response after directional coronary atherectomy (DCA) for left main (LM) bifurcation lesion. Methods. This study was a retrospective, single-center study enrolling 31 patients who underwent stentless therapy using DCA followed by drug-coated balloon (DCB) angioplasty for LM bifurcation lesion. We compared intravascular ultrasound (IVUS) findings before and after DCA. Results. After DCA, the lumen and vessel areas significantly increased, whereas the plaque area (PA) and %PA were significantly reduced. When the lesions were divided into small vessel and large vessel groups using the median value of the vessel area, the maximum balloon pressure of the DCA catheter was greater in the large vessel group. Changes in the lumen and vessel areas were also significantly greater in the large vessel group. On the other hand, the changes in PA and %PA were similar between groups. Conclusions. The main vascular responses associated with lumen enlargement after DCA were plaque reduction and vessel expansion. Contribution of vessel expansion to lumen enlargement was larger than the effect of plaque reduction in large vessel lesions.

One‐year outcomes of patients undergoing percutaneous coronary intervention with the revived directional coronary atherectomy catheter: Insights from the J‐PCI OUTCOME registry

“…The schematic illustrations of the representative treatment strategies in patients undergoing DCA are shown in Figure 4. DCA removes plaque fragments from stenotic sites of the coronary artery and has certain advantages, such as avoiding complex stenting or side branch occlusion 3–5 . Even in cases with DES implantation, improved stent expansion and greater acute gain after DCA may result in a lower restenosis risk 1,3 .…”

“…In addition, the pathological findings of the plaque specimens removed from the coronary artery by DCA may help to clarify the pathogenesis of coronary artery disease in each patient 15 . Furthermore, stentless PCI with DCA followed by adjunctive DCB angioplasty is increasingly being considered as a novel treatment strategy 1,4,5,9 . Conversely, the disadvantages of DCA include the need for the transfemoral approach in most cases with a 7‐Fr or 8‐Fr guiding catheter and precise intravascular ultrasound guidance, resulting in a longer procedural time and a higher contrast volume than standard PCI 1 .…”

“…Previous Japanese studies have reported the midterm outcomes of patients undergoing DCA with a specific treatment strategy, such as DCA with DES 3 or DCA with DCB 4,5 . Habara et al 3 reported that DCA before second‐generation DES implantation for bifurcation lesions provided favorable midterm outcomes, with a low target vessel failure rate (3.9%) at 9–12 months of follow‐up ( n = 77) using a multicenter database.…”

“…The directional coronary atherectomy (DCA) catheter (Atherocut™; Nipro) has proven to be a valuable device for plaque reduction and removal during percutaneous coronary intervention (PCI), especially for left main bifurcation lesions 1–5 . Previously, the former DCA catheter (FLEXI‐CUT; Abbott Vascular) was used to perform stentless PCI in the era of plain old balloon angioplasty or bare‐metal stents 6–8 .…”

“…Plaque reduction before drug‐eluting stent (DES) implantation leads to sufficient stent expansion and greater acute gain, which may result in a reduced restenosis risk 1,3 . Moreover, stentless PCI using DCA with adjunctive drug‐coated balloon (DCB) angioplasty has been implemented more recently and has yielded satisfactory midterm results 4,5,9 …”