High speed rotablation to treat instent restenosis in both branches of a coronary bifurcation stenosis.
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Angioplasty, Balloon, Coronary↗
Biomedical subjects
S C Sinha
Publications and source records attributed to S C Sinha.
Immediate and follow-up clinical outcome after multivessel coronary stenting.
Seventy-two out of 656 patients treated by coronary stenting between January 1995 to May 1997 underwent elective multivessel stenting as a strategy for nonsurgical revascularization in patients with two-vessel (n = 37) and three-vessel (n = 35) disease. Their age ranged from 35 to 77 years (mean: 53.6 +/- 9.2) and the majority (77.8%) were males. The patients were included if the target vessel was more than 2.7 mm in diameter and subserved a moderate to large area of viable myocardium, provided the target lesion was considered approachable by stent. In all, 160 stents were deployed in 146 vessels with a mean of 2.2 stents per patient. The procedure was performed on all the target lesions in one stage in 51(70.8%) and two stages in 21(29.2%) patients. Two-vessel stenting was done in all except 2 patients who received stents in all the three major arteries. Successful deployment of the stent was achieved at the target site in all patients without any major in-hospital complications including subacute stent thrombosis, myocardial infarction (MI), emergency bypass graft surgery (CABG) or death. Clinical follow-up was available in 66(91.6%) patients at a mean of 7.8 +/- 5.5 months. The actuarial survival rates were 98.6, 96.7 and 94.6 percent, respectively at one, 3 and 6 to 12 months after the procedure with an event-free survival (absence of death, MI, recurrence of angina or any revascularization) of 98.5 percent at one, 93 percent at 3, 83.2 percent at 6 and 68.4 percent at 12 months. Only 15(22.7%) patients developed any event and target lesion revascularization was required in 8(12%) patients. In conclusion, multivessel stenting in patients with two- and three-vessel coronary disease is feasible, safe and effective in preventing major in-hospital complications as well as reducing the recurrence of clinical events and need for revascularization on follow-up.
Adult↗
Elective stent implantation after optimal debulking for complex coronary lesions: acute and mid-term results.
Between January 1995 to December 1997, 45 patients with complex lesions in coronary arteries were treated by using the strategy of initial debulking with an atherectomy device followed by elective stenting. Their age ranged from 35-73 years (mean +/- SD:53.9 +/- 9.1) and 93.3 percent were males. The lesion morphology was type B1 in 14 (31.1%), B2 in 16 (35.6%) and type C in 13 (28.9%) patients. The choice of atherectomy device, based primarily on the morphology of lesion, was rotational atherectomy in 23 (51.1%) and directional coronary atherectomy in 22 (48.9%) patients. While majority (73.9%) of the lesions treated by rotablation were long, diffuse and calcified, directional atherectomy was preferred for highly eccentric stenoses in large-sized arteries. All patients underwent elective stent implantation after optimal lesion debulking using a mean burr size of 1.74 +/- 0.2mm for rotablation and a 7Fr. atherocath in majority (90.9%) of patients treated by directional coronary atherectomy. Angiographic success was achieved in all, while clinical success was 97.8 percent. One patient died of acute-on-chronic renal failure during hospitalisation. There were no other major in-hospital adverse cardiac events. At a median follow-up of 13 months (range 1-36 months), recurrence of angina developed in 10 (22.7%), out in which target lesion revascularisation was required in 5 (11.4%) and elective coronary artery bypass graft surgery in one (2.2%) patient. The event-free survival as calculated by the Kaplan-Meier method was 85.8 percent at six, 77.2 at 12 71.7 percent at 18 months of follow-up. In conclusion, optimal debulking before stent implantation provides a larger lumen, and thus eliminates sub-acute stent thrombosis in complex coronary lesions. This strategy also resulted in a high incidence of event-free survival and a low frequency of target lesion revascularisation on mid-term follow-up.
Adult↗