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

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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 mm2; P <0.0001), SA (9.62 ± 2.6 vs. 10.7 ± 2.75 mm2; P <0.0001), and EEMA (17.27 <5 vs. 18.1 ± 5 mm2; P <0.0001) and a decrease of RA (7.43 ± 2.63 vs. 3.45 ± 1.39 mm2; P <0.0001). No significant change was observed in the original plaque + media area (7.65 ± 3 vs. 7.38 ± 2.9 mm2; P = NS). Thus, of the total lumen enlargement (5.13 ± 1.85 mm2), 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.

Original languageEnglish
Pages (from-to)166-173
Number of pages8
JournalCatheterization and Cardiovascular Interventions
Volume56
Issue number2
DOIs
Publication statusPublished - 2002

Fingerprint

Balloon Angioplasty
Stents
Coronary Angiography
Membranes
Pathologic Constriction

Keywords

  • Cutting balloon
  • In-stent restenosis
  • Intravascular ultrasound

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging

Cite this

@article{806474819af648d2a78b01b8b0325385,
title = "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 mm2; P <0.0001), SA (9.62 ± 2.6 vs. 10.7 ± 2.75 mm2; P <0.0001), and EEMA (17.27 <5 vs. 18.1 ± 5 mm2; P <0.0001) and a decrease of RA (7.43 ± 2.63 vs. 3.45 ± 1.39 mm2; P <0.0001). No significant change was observed in the original plaque + media area (7.65 ± 3 vs. 7.38 ± 2.9 mm2; P = NS). Thus, of the total lumen enlargement (5.13 ± 1.85 mm2), 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.",
keywords = "Cutting balloon, In-stent restenosis, Intravascular ultrasound",
author = "Piero Montorsi and Stefano Galli and Franco Fabbiocchi and Alessandro Loaldi and Daniela Trabattoni and Luca Grancini and Sergio Cozzi and Paolo Ravagnani and Oberdan Parodi and Bartorelli, {Antonio L.}",
year = "2002",
doi = "10.1002/ccd.10191",
language = "English",
volume = "56",
pages = "166--173",
journal = "Catheterization and Cardiovascular Interventions",
issn = "1522-1946",
publisher = "John Wiley and Sons Inc.",
number = "2",

}

TY - JOUR

T1 - Mechanism of cutting balloon angioplasty for in-stent restenosis

T2 - An intravascular ultrasound study

AU - Montorsi, Piero

AU - Galli, Stefano

AU - Fabbiocchi, Franco

AU - Loaldi, Alessandro

AU - Trabattoni, Daniela

AU - Grancini, Luca

AU - Cozzi, Sergio

AU - Ravagnani, Paolo

AU - Parodi, Oberdan

AU - Bartorelli, Antonio L.

PY - 2002

Y1 - 2002

N2 - 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 mm2; P <0.0001), SA (9.62 ± 2.6 vs. 10.7 ± 2.75 mm2; P <0.0001), and EEMA (17.27 <5 vs. 18.1 ± 5 mm2; P <0.0001) and a decrease of RA (7.43 ± 2.63 vs. 3.45 ± 1.39 mm2; P <0.0001). No significant change was observed in the original plaque + media area (7.65 ± 3 vs. 7.38 ± 2.9 mm2; P = NS). Thus, of the total lumen enlargement (5.13 ± 1.85 mm2), 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.

AB - 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 mm2; P <0.0001), SA (9.62 ± 2.6 vs. 10.7 ± 2.75 mm2; P <0.0001), and EEMA (17.27 <5 vs. 18.1 ± 5 mm2; P <0.0001) and a decrease of RA (7.43 ± 2.63 vs. 3.45 ± 1.39 mm2; P <0.0001). No significant change was observed in the original plaque + media area (7.65 ± 3 vs. 7.38 ± 2.9 mm2; P = NS). Thus, of the total lumen enlargement (5.13 ± 1.85 mm2), 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.

KW - Cutting balloon

KW - In-stent restenosis

KW - Intravascular ultrasound

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U2 - 10.1002/ccd.10191

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SN - 1522-1946

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