Background: Directional coronary atherectomy prior to stent implantation (DCA-stent) is expected to be an effective approach to reduce restenosis. The purpose of this study was to determine whether DCA-stent has advantages over DCA alone or stenting alone using serial intravascular ultrasound (IVUS). Methods and Results: Serial (pre-, post- and follow-up) IVUS was performed in 187 native coronary lesions treated with each of the 3 strategies. External elastic membrane cross-sectional area (CSA), lumen CSA and plaque CSA were measured. Baseline characteristics were similar. Postprocedural lumen CSA was largest after DCA-stent (11.2±2.7 mm2) and DCA (10.8±2.5 mm2) than stenting alone (9.0±2.9 mm 2) (p<0.0005). Follow-up lumen loss was similar. As a result, follow-up lumen CSA was largest after DCA-stent (DCA-stent: 9.1±3.4 mm2, DCA: 7.8±4.2 mm2, stent: 6.3±2.6 mm2, p<0.0005). There was a trend toward a lower rate of restenosis with DCA-stent (DCA-stent, 12.5%; DCA, 18.3%; stent, 18.8%; p=0.57). Conclusions: DCA-stent is superior to both DCA alone and stent alone in terms of the ability to gain a larger lumen as assessed by IVUS.
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