Effects of adjunctive balloon angioplasty after intravascular ultrasound-guided optimal directional coronary atherectomy : The result of adjunctive balloon angioplasty after coronary atherectomy study (ABACAS)

OBJECTIVES This study was conducted to evaluate: 1) the effect of adjunctive percutaneous transluminal coronary angioplasty (PTCA) after directional coronary atherectomy (DCA) compared with stand-alone DCA, and 2) the outcome of intravascular ultrasound (IVUS)-guided aggressive DCA. BACKGROUND It has been shown that optimal angiographic results after coronary interventions are associated with lower incidence of restenosis. Adjunctive PTC after DC improves the acute angiographic outcome; however, long-term benefits of adjunctive PTC have not been established. METHODS Out of 225 patients who underwent IVUS-guided DCA, angiographically optimal debulking was achieved in 214 patients, then they were randomized to either no further treatment or to added PTCA. RESULTS Postprocedural quantitative angiographic analysis demonstrated an improved minimum luminal diameter (2.88 ± 0.48 vs. 2.6 ± 0.51 mm; p = 0.006) and less residual stenosis (10.8% vs.15%; p = 0.009) in the adjunctive PTC group. Quantitative ultrasound analysis showed larger minimum luminal diameter (3.26 ± 0.48 vs. 3.04 ± 0.5 mm; p < 0.001) and lower residual plaque mass in the adjunctive PTC group (42.6% vs. 45.6%; p < 0.001). Despite the improved acute findings in the adjunctive PTC group, six-month angiographic and clinical results were not different. The restenosis rate (adjunctive PTC 23.6%, DC alone 19.6%; p = ns) and target lesion revascularization rate (20.6% vs. 15.2%; p = ns) did not differ between the groups. CONCLUSIONS With IVUS guidance, aggressive DC can safely achieve optimal angiographic results with low residual plaque mass, and this was associated with low restenosis rate. Although adjunctive PTC after optimal DC improved the acute quantitative coronary angiography and quantitative coronary ultrasonography outcomes, its benefit was not maintained at six months.