Effect of plaque debulking before stent implantation on in-stent neointimal proliferation: A serial 3-dimensional intravascular ultrasound study

Abstract Background Recent intravascular ultrasound (IVUS) studies have suggested that plaque burden has a role in promoting intimal hyperplasia after stenting. We report on volumetric assessments of in-stent neointimal formation with 3-dimensional IVUS analysis, comparing directional coronary atherectomy (DCA) plus stenting (DCA/stenting) to stenting without DCA. Methods Twenty-four patients (24 lesions) treated with DCA before stenting were matched to 24 patients (24 lesions) receiving stenting without DCA. All stents were a single Multilink stent. In both groups, serial IVUS was performed before and after intervention and during the 6-month follow-up period. The arterial segments that were analyzed with a computer-based contour detection program were the same as the stented segments analyzed on serial studies. These measurements were obtained: (1) lumen volume (LV), (2) stent volume (SV), (3) vessel volume (VV), (4) in-stent neointimal volume (ISV) calculated as SV-LV, and (5) percent in-stent neointimal volume (%ISV) calculated as ([SV-LV]/SV) × 100. Results Baseline characteristics of the 2 groups were similar. After intervention, both groups achieved similar LV (140.0 mm 3 DCA/stenting vs 135.2 mm 3 stenting alone). However, the follow-up ISV and %ISV were significantly smaller in the DCA/stenting group (19.6 ± 12.2 mm 3 DCA/stenting vs 44.6 ± 29.5 mm 3 stenting alone; P = .00040; 15.3% ± 10.6% DCA/stenting vs 31.5% ± 17.7% stenting alone; P = .00040). Consequently, the DCA/stenting group showed a significantly greater follow-up LV (121.0 ± 51.5 mm 3 DCA/stenting vs 91.5 ± 26.7 mm 3 stenting alone; P = .016). Conclusions Plaque removal with DCA before stenting inhibits in-stent neointimal hyperplasia.