INFLUENCE OF PLAGUE COMPOSITION ON LUMINAL GAIN AFTER BALLOON ANGIOPLASTY, DIRECTIONAL ATHERECTOMY, AND CORONARY STENTING

This study was conducted to correlate the acute luminal enlargement ac hieved by three different nonsurgical revascularization procedures in 79 patients (32 treated by balloon angioplasty, 29 by directional athe rectomy, and 18 by coronary stenting) with the morphologic characteris tics of coronary plaques assessed by preprocedure intravascular ultras ound. The absolute luminal gain was 2.41 +/- 1.54 mm(2) for balloon an gioplasty, 3.17 +/- 1.8 mm(2) for directional atherectomy, and 4.56 +/ - 1.45 mm(2) for coronary stenting (p = 0.00005). However, when lumina l gain was corrected for the external vessel area (luminal gain index) , such difference was no longer present (0.22 +/- 0.12 for balloon ang ioplasty, 0.24 +/- 0.15 for directional atherectomy, and 0.30 +/- 0.12 for coronary stenting, p = not significant). Concentric plaques treat ed by coronary stenting had a higher luminal gain index than eccentric plaques (p = 0.01). A comparison of the three devices showed that a s imilar luminal gain index was achieved in soft plaques, whereas corona ry stenting was superior to directional atherectomy (0.41 +/- 0.10 vs 0.20 +/- 0.09, p = 0.002) and balloon angioplasty(0.41 +/- 0.10 vs 0.1 9 +/- 0.08, p = 0.0005) in concentric plaques. Coronary stenting also induced a greater luminal gain index than directional atherectomy in c alcific plaques (0.30 +/- 0.11 vs 0.18 +/- 0.09, p = 0.04). In conclus ion, these data show that plaque morphology assessed by preprocedure i ntracoronary ultrasound influences the acute luminal enlargement achie ved by different coronary interventions. The knowledge of plaque compo sition may be useful in guiding the choice of the device to be used to obtain a larger acute luminal gain.