Author + information
- Received April 20, 1992
- Revision received July 20, 1992
- Accepted July 28, 1992
- Published online February 1, 1993.
- JoséSuárez De Lezo, MDa,∗,
- Miguel Romero, MDa,
- Alfonso Medina, MD∗,
- Manuel Pan, MDa,
- Djordje Pavlovic, MDa,
- Ricardo Vaamonde, MDa,
- Enrique Hernández, MD∗,
- Francisco Melián, MD∗,
- Fernando López Rubio, MDa,
- José Marrero, MD∗,
- José Segura, MDa,
- Maria Irurita, MD∗ and
- Jose A. Cabrera, MD∗
- ↵∗Address for correspondence: José Suárez de Lezo, MD, Servicio de Cardiologia, Hospital Reina Sofia, Avenida Menéndez Pidal, 1, 14004 Córdoba, Spain.
Objectives. This study was conducted to assess the relations among intracoronary ultrasound, angiographic and histologic data obtained from patients with coronary artery disease successfully treated by directional coronary atherectomy. In addition, it was designed to elucidate whether some aspects of intravascular ultrasound or pathologic findings could predict a propensity to restenosis.
Background. Intracoronary ultrasound is a useful technique in guiding and assessing atherectomy. However, there is little information about the characterization of the different types of coronary plaques and the changes observed in them after resection. Furthermore, the follow-up ultrasound appearance of previously treated lesions remains undepicted.
Methods. Fifty-two patients (54 ± 10 years old) were studied. All were successfully treated by atherectomy with the aid of intracoronary ultrasound guidance. Qualitative and quantitative ultrasound and angiographic variables were derived before and after resection. Quantitative histologic morphometric information was also obtained from the specimens. In 22 patients, a follow-up echoangiographic reevaluation was performed 6 ± 4 months later.
Results. Echogenic plaques had a higher collagen and calcium content, whereas echolucent plaques had an increased level of fibrin, nuclel and lipids. Ultrasound plaque reduction after atherectomy was greater in echolucent (76 ± 21%) than in echogenic plaques (60 ± 18%; p < 0.05). That reduction correlated with the weight of the resected material (r = 0.62; p < 0.01). At follow-up study, 13 of 22 patients had angiographic and ultrasound evidence of restenosis. Most recurrent lesions had a stenotic three-layer appearance. The incidence of restenosis of primary lesions treated with atherectomy was higher in echolucent (100%) than in echogenic (33%) plaques. Similarly, a higher proportion of nuclear content in the resected material was observed in patients who developed restenosis (2.1 ± 0.7%) than in patients who had late success after atherectomy (1.2 ± 0.6%).
Conclusions. Our findings suggest that echolucent plaques are easier to resect than are echogenic plaques but frequently develop restenosis. In contrast, the resection of echogenic plaques, although often incomplete, is associated with better long-term results.
☆ This study was supported in part by the Fondo de Investigación Sanitaria, Madrid, Spain.
- Received April 20, 1992.
- Revision received July 20, 1992.
- Accepted July 28, 1992.