Reduction of restenosis by vessel size adapted percutaneous transluminal coronary angioplasty using intravascular ultrasound

Restenosis following percutaneous transluminal coronary angioplasty (PTCA) remains a serious problem in interventional cardiology. Recent trials using stent implantation have proposed a reduction in restenosis, presumably due to a higher initial luminal gain. This study was conducted to evaluate if the short- and long-term results following conventional PTCA may be favorab le, if balloon dilation; was performed according to measurements gained by intravascular ultrasound (IVUS) (vessel size adapted PTCA). The use of intr acoronary stents might be omitted if comparable long-term results could be achieved by this modified technique of balloon angioplasty. This unicenter and nonrandomized pilot trial was initiated in January 1995 with 252 patien ts who had 271 lesions, IVUS was performed before and after intervention to determine the external elastic membrane (EEM) diameter at the lesion site. The balloon catheter was sized according to the EEM diameter measured by I VUS (EEM 10%). The mean balloon diameter was 4.1 +/- 0.5 mm, the dilation t ime 130 +/- 60 seconds with a balloon pressure of 7.0 +/- 2.0 atm. Clinical acute and 1-year long-term follow-up were obtained for all patients and fo llow-up angiography in 71% of patients. Acute events occurred postintervent ionally in 5 patients (2%). The cumulative event rate during long-term foll ow-up was 14%. The angiographic restenosis rate (diameter stenosis >50%) af ter 1 year was 19%. Vessel size adapted PTCA using IVUS led to favorable ac ute and long-term results with a low restenosis rate and a low 1-year clini cal event rate. Despite dissections that occur frequently using large ballo on sizes, on increased rate of major complications did not occur, indicatin g a safe procedure and substantiating the philosophy of "therapeutic dissec tions." The results need to be verified in a randomized trial. (C) 1999 by Excerpta Medico, Inc.