CLASSIFICATION OF MORPHOLOGIC EFFECTS OF PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY ASSESSED BY INTRAVASCULAR ULTRASOUND

The aim of this study was the assessment and classification of the morphologic effects of percutaneous transluminal angioplasty (PTCA) by intravascular ultrasound (IU). Fifty-eight patients wore examined immediately after PTCA with a 4.8Fr, 20 MHz rotational tip IU system. In 10 patients (17%), IU images could not be analyzed duo to failure of the imaging system or poor image quality. In 48 patients (83%; 40 men and 8 women, aged 55 +/- 9 years), IU images of 48 PTCA segments, as well as 41 distal and 44 proximal sites, wore analyzed. The left anterior descending artery was studied in 30 patients, the right coronary artery in 17 and the left main coronary artery in 1. Calcium was present in 32 of 48 PTCA segments (67%). Plaque morphology was concentric in 18 patients (38%) and eccentric in 30 (62%). Seven distinct morphologic patterns were observed. In concentric plaques, plaque compression without significant wall alterations (type 1) was found in 2 patients (4%), superficial tears within the plaque (type 2) in 1 (2%) and deep tears (type 3) in 8 (17%). Deep tearing associated with submedial or subintimal dissection (typo 4) was found in 2 patients (4%). Dissection between plaque and vessel wall without noticeable intimal tearing (typo 5) was the most common morphology (n = 15; 31%) and occurred in concentric and eccentric plaques. in eccentric plaques, no significant tearing of the plaque (type 6) was found in 6 patients (13%), and tearing of the plaque close to its base with dissection typo 7) in 14 (29%). In the PTCA segment, minimal luminal diameter was 3.5 +/- 0.7 mm, maximal luminal diameter 4.3 +/- 0.8 mm, luminal area 11.8 +/- 4.1 mm2, plaque area 9.6 +/- 5.5 mm2 and vessel area 23.1 +/- 6.9 mm2. Moan residual stenosis was 40%, mean recoil was -13%, and the correlation between luminal diameter and balloon size was low (r = 0.18). IU is a now imaging modality that enables qualitative and quantitative assessment of coronary arteries after PTCA. A classification of IU findings after PTCA is proposed.