COMPARISON OF INTRAVASCULAR ULTRASONOGRAPHY AND INTRAARTERIAL DIGITALSUBTRACTION ANGIOGRAPHY AFTER DIRECTIONAL ATHERECTOMY OF SHORT LESIONS IN FEMOROPOPLITEAL ARTERIES

Purpose: In this study a group of patients undergoing directional athe rectomy for localized occlusive disease in the femoropopliteal arterie s, the value of intravascular ultrasonography (IVUS) to improve the ef ficacy of plaque removal was evaluated. The findings obtained by IVUS were correlated with intraarterial digital subtraction angiography (IA DSA) performed during the procedure. In addition, the patency rates a t follow-up in patients undergoing atherectomy with and without IVUS w ere compared. Methods: Forty patients were treated by atherectomy beca use of segmental lesions of the femoropopliteal arteries causing inter mittent claudication. Twenty-two patients underwent atherectomy, guide d by biplane IA DSA only, and 18 patients were also studied by IVUS. T he groups were divided by means of consecutive presentation, IVUS bein g used in the second part of the study period. The median follow-up wa s 16 months (range, 0 to 40 months). Variables, measured by IVUS durin g the procedure, were the minimal transverse luminal diameter (MTLD) a nd the free luminal area. Patency rates at follow-up were determined b y regular color-flow duplex examinations. Color-how duplex criteria fo r occlusion were absence of arterial flow and, for restenosis, a ratio of peak systolic velocities at the diseased segment and a normal segm ent of 2.5 or greater. Results: Qualitative IVUS assessment prompted a dditional atherotome passages because of insufficient atheroma removal or nonaesthetic appearance of the vessel lumen in 15 of the 18 patien ts who underwent this examination. Only in four of these patients woul d abnormalities at IA DSA have been a reason for further attempts of a theroma removal. As for the quantitative findings during AT, after a f irst series of atherectomy passes the mean MTLD of the reference lesio n resulted in an increase of the MTLD from a mean of 3.3 +/- 0.7 mm to 3.7 +/- 0.6 mm (p = 0.001), and the free luminal area increased from a mean of 11.2 +/- 4.8 mm(2) to 12.5 +/- 4.5 mm(2) (p = 0.001). Howeve r, the occurrence of restenosis during follow-up was comparable in pat ients monitored during the intervention by IVUS (1-year patency rate, 57%) and patients not studied by IA DSA only (1-year patency rate, 64% ). In addition, the presence of an intimal dissection or a plaque rupt ure at IVUS examination did not predict restenosis. Conclusions: The a pplication of IVUS resulted in an improved luminal enlargement by dire ctional atherectomy but not in a better 1-year patency rate.