Influence of plaque composition on luminal gain after balloon angioplasty, directional atherectomy, and coronary stenting

This study was conducted to correlate the acute luminal enlargement achieved by three different nonsurgical revascularization procedures in 79 patients (32 treated by balloon angioplasty, 29 by directional atherectomy, and 18 by coronary stenting) with the morphologic characteristics of coronary plaques assessed by preprocedure intravascular ultrasound. The absolute luminal gain was 2.41 ± 1.54 mm2 for balloon angioplasty, 3.17 ± 1.8 mm2 for directional atherectomy, and 4.56 ± 1.45 mm2 for coronary stenting (p = 0.00005). However, when luminal gain was corrected for the external vessel area (luminal gain index), such difference was no longer present (0.22 ± 0.12 for balloon angioplasty, 0.24 ± 0.15 for directional atherectomy, and 0.30 ± 0.12 for coronary stenting, p = not significant). Concentric plaques treated by coronary stenting had a higher luminal gain index than eccentric plaques (p = 0.01). A comparison of the three devices showed that a similar luminal gain index was achieved in soft plaques, whereas coronary 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 0.19 ± 0.08, p = 0.0005) in concentric plaques. Coronary stenting also induced a greater luminal gain index than directional atherectomy in calcific plaques (0.30 ± 0.11 vs 0.18 ± 0.09, p = 0.04). In conclusion, these data show that plaque morphology assessed by preprocedure intracoronary ultrasound influences the acute luminal enlargement achieved by different coronary interventions. The knowledge of plaque composition may be useful in guiding the choice of the device to be used to obtain a larger acute luminal gain.