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PubMed1996

Percutaneous rotational coronary atherectomy: initial Green Lane and Mercy hospitals' experience.

AIMS: Rotational atherectomy is a new interventional technique and can be used as an alternative percutaneous treatment for selected coronary atherosclerotic lesions. We report the initial Green Lane/Mercy hospitals experience with rotational atherectomy and review the published international experience with the device. METHODS: Patient case notes and prospectively recorded New Zealand national angioplasty data forms were reviewed for basic demographic data and angina symptoms, in-hospital complications and length of the hospital stay. Catheter laboratory worksheets were reviewed to obtain the duration of ablation, burr diameter and adjunctive PTCA balloon diameter. RESULTS: The main indications for rotational atherectomy were heavy lesion calcification, ostial location, or failure of an angioplasty balloon to cross or to dilate the lesion. Procedural success was achieved in 28 of 30 patients (93%). One patient suffered a Q wave myocardial infarction and in another the lesion could not be crossed with the guide wire. Two patients required repeat balloon angioplasty for early reocclusion without other sequelae and one patient had directional atherectomy 2 weeks later for ongoing sumptoms. CONCLUSION: Rotational atherectomy is a useful adjunct to the percutaneous devices available to treat coronary disease.

Adult↗
PubMed1997

Clinical outcomes of patients more than one year following randomization in the Canadian Coronary Atherectomy Trial (CCAT).

BACKGROUND: The Canadian Coronary Atherectomy Trial (CCAT) assessed, in a randomized comparison, the clinical and angiographic outcomes following atherectomy with those following balloon angioplasty for the treatment of de novo lesions in the proximal one-third of the left anterior descending artery (LAD). Although the procedural success rate was somewhat higher and the postprocedure lumen larger in patients treated with atherectomy, lumen dimensions, restenosis rates and clinical outcomes were similar in the two groups at six months. To determine whether late differences emerged between the groups, clinical follow-up was obtained at a median of 18 (range 10 to 31) months after randomization. METHODS AND RESULTS: Patients were contacted monthly by telephone for the first six months. Subsequent follow-up information was obtained in 272 (99%) of the 274 randomized patients via a clinic visit or telephone interview with the patient and/or a relative. Additional information was obtained from the referring physician as required. There were no differences in adverse events between the two groups during follow-up. In patients randomized to atherectomy compared with balloon angioplasty, death occurred in 1.5% versus 2.2% (cardiac death 0.7% versus 0.7%); myocardial infarction in 5.1% versus 5.9% (Q wave 1.5% versus 1.5%); coronary bypass surgery in 13.1% versus 12.6%; and repeat target lesion intervention in 22.6% versus 21.5%. Persistent or recurrent Canadian Cardiovascular Society class III/IV angina not treated by a further intervention was present in 1.5% versus 2.2%. The combined end-point of death or nonfatal myocardial infarction occurred in nine (6.6%) versus 11 (8.1%) patients and any adverse cardiac event in 50 (36.5%) versus 53 (39.3%). Multivariate logistic regression indicated that unstable angina, reference vessel size and preprocedure minimum lumen diameter were the only variables independently associated with adverse events. CONCLUSIONS: The initial choice of directional atherectomy or balloon angioplasty had no impact on clinical outcome over a period of 18 months in this patient population. With either technique, just over 60% of patients with proximal LAD disease experienced sustained symptomatic improvement without an adverse event following a single procedure, and 80% achieved this status following a repeat percutaneous intervention.

Angioplasty, Balloon, Coronary↗
PubMed1997

[Restenosis after optimal coronary atherectomy and influence on left ventricular function].

The authors prospectively assessed 95 patients undergoing optimal guided atherectomy to assess the incidence of restenosis at 6 months. The coronary lesions were measured by a system of quantitative angiography to ensure reproducibility. Ventricular volumes, ejection fraction and segmental wall motion were assessed by ventriculography performed in the right anterior oblique projection. Sixty-three patients underwent atherectomy of the left anterior descending artery and 32 patients of the right coronary artery. The reference diameter was 3.58 +/- 0.65 mm. Atherectomy increased the minimal diameter of the lesion from 1.19 +/- 0.44 to 3.03 +/- 0.45 mm, with a residual stenosis of 14 +/- 10% of the diameter. At 6 months, 23% of patients had restenosed (> 50% stenosis) with a residual lumen at 1.16 +/- 0.39 mm. In the absence of restenosis, there was no significant change in left ventricular volumes or pressures and the global ejection fraction increased by +4 +/- 9% (p < 0.01), mainly in the group undergoing left anterior descending atherectomy. Moreover, fractional shortening increased in the anterior segments (+11 +/- 18%; p < 0.001). The authors conclude that optimal atherectomy is associated with acceptable rates of restenosis and that medium-term benefits of segmental wall motion are observed in patients without angiographic restenosis, mainly in those undergoing the procedure on the left anterior descending artery.

Adult↗
PubMed1997

[Local progression of atherosclerosis after optimal directional atherectomy. Endocoronary ultrasonography of 17 patients].

In vivo endovascular ultrasonography has confirmed the extension of atheroma to angiographically normal segments. The authors set out to determine by endocoronary ultrasonography if the introduction of the atherotome changed the intimal thickness 20 mm proximal and distal to the site treated. The area circumscribed by the external elastic layer (EEL) and the surface area of the lumen was measured in 17 patients: 1) before atherectomy; 2) after atherectomy; 3) at control 6 months later. Atherectomy immediately increased the luminal area at the site dilated from 1.9 + 0.9 to 8.1 +/- 2mm (p < 0.001). At the proximal segment, the surface area of the lumen was unchanged (mean + 0.6 +/- 1.5 mm2; p = 0.13). Similarly the procedure did not change the surface circumscribed by the EEL (mean + 0.8 +/- 3.2 mm2; p = 0.32) in this zone. The same results were observed at the distal site. At 6 months, the areas under the EEL and those of the lumen were unchanged at the unoperated sites. The mean of the differences (+/- 1 SD) for the area under the EEL was respectively -0.2 +/- 1.5 mm2 proximally and +0.7 +/- 2.5 mm2 distally. The means for the luminal area were 0.2 +/- 1 mm2 proximally and -0.01 +/- 1.1 mm2; distally. At the site of atherectomy, the luminal surface increased (+2.0 +/- 2.6 mm2; p < 0.01) as did the area under the EEL (+2.0 +/- 3.5 mm2; p < 0.05). This preliminary series shows no significant progression of atherosclerosis at the sites not affected by atherectomy.

Adult↗
PubMed1990

Quantitative angiographic comparison of the immediate success of coronary angioplasty, coronary atherectomy and endoluminal stenting.

Coronary atherectomy and coronary stenting effectively reduce the severity of coronary artery stenoses, but direct comparisons of these interventions with conventional balloon angioplasty have not been performed. To compare the immediate efficacy of these 3 interventions, the angiographic morphology and the severity of the residual coronary stenosis were quantitatively evaluated in 18 patients undergoing coronary atherectomy and in 21 patients treated by endoluminal coronary stenting. Each of these groups of patients was compared with a matched group of coronary angioplasty patients selected from a large, computerized data-base. The variables matched included patient age and sex, lesions site and severity, and lesion complexity. Both coronary atherectomy and coronary stenting more effectively reduced the severity of the coronary stenosis when compared with balloon angioplasty. The luminal diameter stenosis was reduced from 69 +/- 10 to 22 +/- 20% in the atherectomy group compared with a reduction from 74 +/- 11 to 44 +/- 14% in the matched coronary angioplasty population (p = 0.008). Similarly, the luminal diameter stenosis was reduced from 77 +/- 11 to 26 +/- 12% in the stented group compared with a reduction from 81 +/- 10 to 42 +/- 14% in the matched coronary angioplasty group (p = 0.014). In addition, moderate or severe coronary dissections were noted more frequently in the coronary angioplasty groups than in their respective atherectomy and stent groups (0 vs 33%, p = 0.008, and 5 vs 19%, p = 0.15, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1991

Comparative quantitative angiographic analysis of directional coronary atherectomy and balloon coronary angioplasty.

An attempt to assess the "utility" of directional atherectomy was made using a new quantitative angiographic index. This index can be subdivided into an initial gain component and a restenosis component. The initial gain index is the ratio between the gain in diameter during intervention and the theoretically achievable gain (i.e., reference diameter). The restenosis index is the ratio between the decrease at follow-up and the initial gain during the procedure. The net result at long-term follow-up is characterized by the utility index, which is the ratio between the final gain in diameter at follow-up and what theoretically could have been achieved. For this purpose, 30 coronary artery lesions were selected from a consecutive series of successfully dilated primary angioplasty lesions and were matched with the initial 30 successfully treated primary atherectomy lesions. Matching by location of stenosis and reference diameter resulted in 2 comparable groups with identical preprocedural stenosis characteristics. Atherectomy resulted in an increase in minimal luminal diameter 2 times larger than angioplasty (1.53 vs 0.77 mm; p less than 0.0001). However, at follow-up there was a significant decrease in minimal luminal diameter and a significant increase in percent diameter stenosis in the groups with atherectomy and angioplasty (1.69 +/- 0.58 vs 1.57 +/- 0.58 mm, p = not significant [NS], and 37 +/- 18 vs 47 +/- 18%, p = NS, respectively). The decrease in minimal luminal gain was more pronounced in the group with atherectomy than in that with angioplasty (0.92 +/- 0.69 vs 0.35 +/- 0.51 mm; p = 0.0005).(ABSTRACT TRUNCATED AT 250 WORDS)

Angioplasty, Balloon, Coronary↗
PubMed1992

Restenosis after directional coronary atherectomy.

OBJECTIVES: This study evaluates the incidence of restenosis after successful directional coronary atherectomy and identifies risk factors for restenosis. BACKGROUND: Directional coronary atherectomy has been shown to be a safe and effective treatment of obstructive coronary artery disease; however, information regarding restenosis is limited. METHODS: Between October 1986 and December 1989, 289 patients with 332 lesions were successfully treated with directional coronary atherectomy and followed up prospectively. Clinical follow-up information was available for 98% and angiographic follow-up information was obtained for 82% at approximately 6 months, or earlier if symptoms recurred. Angiograms were quantitatively analyzed. Restenosis was defined as greater than 50% stenosis at the site of intervention. RESULTS: Seventy-four percent of patients were either asymptomatic or clinically improved after the procedure. Thirty-two percent were subsequently treated by coronary artery bypass surgery (14%), percutaneous transluminal coronary angioplasty (4%) or repeat atherectomy (13%). Angiographic evidence of restenosis was observed in 42%. The restenosis rate in native coronary arteries was 31% for primary lesions and 28% and 49%, respectively, for lesions treated with one or two previous angioplasty procedures. The restenosis rate for saphenous vein grafts was 53% for primary lesions and 58% and 82%, respectively, for lesions treated with one or two previous angioplasty procedures. The median interval to angiographically documented restenosis was 133 days. A higher restenosis rate was associated with a saphenous vein graft, hypertension, a longer lesion (greater than or equal to 10 mm), a smaller vessel diameter (less than 3 mm), a noncalcified lesion and use of a smaller (6F) device. CONCLUSIONS: Restenosis remains a limitation of directional coronary atherectomy. A subset of patients with larger vessels, shorter lesions or lesions treated with a larger (7F) device may have a more favorable outcome.

Aged↗
PubMed1988

Transluminal atherectomy for occlusive peripheral vascular disease.

Sixty-one patients with occlusive peripheral vascular disease were treated with transluminal atherectomy, a catheter-mediated technique for removal of atheroma. The technique was performed using 7Fr, 9Fr or 11Fr atherectomy catheters. Mean percent diameter stenosis was reduced from 71 to 23%, by removal of 831 atheromatous specimens in 949 passes of the cutting element through 136 stenoses in 61 patients. All specimens removed were sent for histopathologic examination to determine the components of the atheroma removed, which differed for specimens removed from original vs restenotic lesions. Percent stenosis was reduced to less than 45% in 118 of 136 stenoses (87%). Complications included 1 thrombus, which resolved after intraarterial infusion of streptokinase and 1 probable distal embolization without sequelae. Three angiographic dissections occurred without impairment of blood flow. There were no instances of acute occlusion, vascular spasm or vessel perforation. Six-month follow-up angiography was performed showing that patients who had a residual stenosis less than 30% after initial atherectomy had a lower restenosis rate (18%) than patients with initial residual stenoses greater than 30% (52%); this result demonstrated the importance of performing more complete atherectomy. Transluminal atherectomy appears to be an effective, predictable and safe method for removing occlusive atheromatous deposits from peripheral arteries.

Angioplasty, Balloon↗
PubMed1991

Effects of intracoronary nitroglycerin on lumen diameter during early follow-up angiography after coronary excimer laser atherectomy.

The incidence of coronary vasospasm during and following excimer laser atherectomy is considerable. The aim of this study was to investigate vasoconstriction of the target vessel during early follow-up angiography. In 50 patients an angiogram was performed 24 hours after intervention. Nineteen patients were treated with stand-alone laser atherectomy (group I), another 19 with laser and additional balloon angioplasty (group II) and 12 with balloon angioplasty alone (group III). Lumen diameter and percent stenosis before and after intracoronary application of 0.1 mg nitroglycerin were determined. The differences were compared between groups I, II and III, and for patients with (N = 14) and without (N = 24) vasospasm during laser atherectomy. There was a significant increase in lumen diameter, of 0.17 +/- 0.28 mm, after nitroglycerin in group I, of 0.18 +/- 0.29 mm in group II (P = 0.02) and of 0.03 +/- 0.21 mm in group III (ns). In patients with vasospasm during laser atherectomy the average increase in lumen diameter was 0.28 +/- 0.24 mm (P less than 0.01), and in patients without vasospasm 0.12 +/- 0.29 mm (P = 0.09). We conclude that one day after coronary excimer laser atherectomy intracoronary nitroglycerin significantly affects lumen diameter at the site of previous stenosis, an effect undetectable after balloon angioplasty. Thus, vasoconstriction after excimer laser ablation seems to be a common phenomenon and is prolonged in patients with vasospasm during the previous intervention.

Adult↗
PubMed1988

Peripheral artery atherectomy: description of technique and report of initial results.

Percutaneous transluminal atherectomy has been developed for treatment of peripheral artery stenoses. The atherectomy catheter is inserted through a sheath, and the resection window of the catheter is positioned adjacent to the vascular stenosis. The balloon is inflated, and the motor-driven cutting blade advanced. The balloon is then deflated, the catheter withdrawn, and the atheromatous material, which resembles the resected material of an endarterectomy, removed from the catheter. This process is repeated until the resection provides an adequate lumen. To date, 12 arterial lesions (three common iliac, two external iliac, four superficial femoral, and three popliteal artery) in ten patients have been resected with excellent angiographic results. The conditions of seven patients who underwent atherectomy for relief from claudication were improved by the criteria of ankle/arm ratios and/or claudication distance. Three patients successfully underwent atherectomy for limb salvage. More data on long-term patency and restenosis rates are needed before the ultimate role of atherectomy in the management of peripheral artery disease can be determined.

Adult↗
PubMed1991

Relation of stenosis morphology and clinical presentation to the procedural results of directional coronary atherectomy.

BACKGROUND: Directional coronary atherectomy has recently become available to treat coronary stenoses. This study was performed to determine the relation of patient characteristics and stenosis morphology to procedural outcome with directional coronary atherectomy to gain insight into which patients might be best treated with this device. METHODS AND RESULTS: Four hundred stenoses from 378 patients consecutively treated at six major referral institutions were analyzed. Angiographic data were assessed at a central angiographic laboratory using standardized morphological criteria and computer-assisted quantitative dimensional analyses. Procedural success was achieved in 87.8% of stenoses, and major ischemic complications (death, myocardial infarction, and emergency bypass surgery) occurred in 6.3% of patients. Lesion success and complications were closely correlated with recognized modified American College of Cardiology/American Heart Association Task Force lesion morphological criteria. Observed for type A stenoses were 93% success and 3% complication rates; for type B1 stenoses, 88% success and 6% complication rates; and for type B2 stenoses, 75% success and 13% complication rates, respectively. There were too few type C stenoses treated to analyze. Furthermore, multivariate testing demonstrated stenosis angulation (multivariate p less than 0.001), proximal tortuosity (p less than 0.001), decreased preatherectomy minimum lumen dimension (p = 0.032), and calcification (p = 0.041) to correlate independently with adverse outcome and complex, probably thrombus-associated stenoses to have a favorable outcome (p = 0.055). Operator experience (p = 0.020) and a history of restenosis (p = 0.022) also favorably influenced outcome. CONCLUSIONS: The procedural outcome of directional coronary atherectomy is highly associated with coronary stenosis morphology. Furthermore, after appropriate stratification for morphology and clinical presentation, overall atherectomy procedural outcome may be similar to that achieved with coronary angioplasty. However, specific subsets of patients may have relatively better outcome with either atherectomy or balloon angioplasty.

Cardiac Catheterization↗
PubMed1992

In vivo assessment of vascular pathology resulting from laser irradiation. Analysis of 23 patients studied by directional atherectomy immediately after laser angioplasty.

BACKGROUND: The pathological consequences of cardiovascular laser irradiation have been studied extensively in vitro. Previous in vivo studies of laser-induced injury have included analyses of acute and/or chronic findings in experimental animals. Little information, however, is available regarding the acute effects of laser irradiation of human vascular tissues in vivo. METHODS AND RESULTS: To determine the acute pathology resulting from laser irradiation of human vascular tissue in vivo, specimens retrieved from 23 patients by directional atherectomy immediately after laser angioplasty (19 peripheral and four coronary) were examined by light microscopy. Of the 23 patients, three (13.0%) were treated with a metal-capped ("hot-tip") fiber coupled to a continuous-wave neodymium:yttrium-aluminum-garnet (Nd:YAG) laser using up to 18 W power and 18-305 seconds of cumulative exposure time; in all three patients (100%), thermal injury, including frank charring several cell layers thick, was seen along the luminal borders of the atherectomy specimen. In eight of the 23 patients (34.5%), laser angioplasty was performed using a 250-microseconds holmium:YAG laser at fluences up to 2,300 mJ/mm2, a repetition rate of 5 Hz, and 25-200 seconds of cumulative exposure; in seven of eight patients (85.5%), the atherectomy specimen showed signs of vacuolar injury consisting of central and satellite Alcian-blue-negative vacuoles. In two patients (25.0%), there was a "smudged" or "shredded" edge, whereas in one patient, frank signs of thermal injury were observed. Finally, in 12 of the 23 patients (52.2%), laser angioplasty was performed using a 120-nsec excimer laser at fluences up to 60 mJ/mm2, a repetition rate of 25 Hz, and a cumulative exposure time of 21-315 seconds. Pathological findings among these 12 patients were limited to nine patients (75%) in whom a weakly basophilic, smudged, and/or shredded appearance approximately one cell layer thick was observed along the luminal border of the atherectomy specimen and two patients (16.7%) with small foci of vacuolar injury. None of the atherectomy specimens retrieved after excimer laser angioplasty disclosed signs of thermal injury. CONCLUSIONS: These findings document that acute pathological alterations resulting from in vivo laser angioplasty are variable, depending on the laser source used, and are similar to that predicted by experimental studies performed previously in vitro. The prognostic implications of these varying pathological features remain to be clarified.

Aged↗
PubMed1992

'Salvage atherectomy' for discrete arterial dissections resulting from balloon angioplasty.

OBJECTIVE: To review the outcome of attempted salvage atherectomy performed following failed balloon angioplasty at a single centre. DESIGN: Retrospective study. PATIENTS: All patients undergoing percutaneous directional atherectomy shortly after failed coronary or peripheral balloon angioplasty at St Paul's Hospital, Vancouver, British Columbia, are reported. INTERVENTIONS: Salvage atherectomy was performed in six patients following failed balloon angioplasty prior to hospital discharge. In each case, a discrete mural flap resulted in a compromised lumen and ischemia. MAIN RESULTS: Percutaneous directional atherectomy successfully recovered atheromatous intimal fragments with restoration of arterial patency in all patients. Media was identified in one specimen and adventitia in none. Perforation did not occur and there were no complications. One patient had documented restenosis and a second had a significant lesion at a more proximal site with a follow-up of four to 15 months (mean nine). Both patients underwent uncomplicated repeat balloon angioplasty without angiographical dissection. CONCLUSIONS: Salvage atherectomy has a limited--but still useful--role in the management of discrete, obstructive arterial dissection flaps complicating balloon angioplasty.

Adult↗
PubMed1992

[Transluminal coronary extraction atherectomy. Method, acute results, angiographic and clinical follow-up].

Transluminal coronary extraction-endarterectomy is an alternative interventional approach for treatment of coronary artery disease. The atherectomy system consists of a catheter assembly including a cutter and torque tube which is rotated at a relatively low rate of 750 rotations per minute, when introduced to the coronary artery over a guide-wire via a guiding catheter. Excised tissue is withdrawn from the coronary artery by suction applied through the catheter by means of an attached vacuum bottle. We report acute results in 18 patients and the clinical outcome of 14 patients who up to now underwent angiographic follow-up catheterization after 6 months. Initial angiographic success (residual stenosis less than 50%) using TEC-atherectomy alone was obtained in 6/18 patients (33%), 11/18 patients (60%) required additional PTCA in order to achieve primary success (9/18) or to treat total occlusion (2/18) after TEC-atherectomy. Major complications consisted in 1-vessel perforation with non-Q-wave-infarction but no need of surgical intervention and 2 occlusions due to dissection (treated with PTCA). 14 patients underwent angiographic follow-up (6 months) and restenosis (greater than 50%) was confirmed in 7 patients (50%). Considering the low primary success rate of TEC-atherectomy alone and the tendency to high restenosis rate, we cannot recommend it as an alternative to conventional PTCA in general clinical practice. Further studies should be designed to directly compare TEC-atherectomy to PTCA in specific patient subgroups (e.g. bypass grafts, intraluminal thrombus, diffuse disease) in order to define the role of this interventional device.

Adult↗
PubMed1990

[Coronary restenosis 6 months following transluminal atherectomy].

UNLABELLED: Directional coronary atherectomy was developed to decrease the incidence of restenosis. Among the first 61 patients treated with directional atherectomy at Mayo Clinic, 50 have been considered a success. Half of the patients had had one or more previous PTCA performed on the target lesion. Patients were followed during 6 months. Coronary angiogram was performed 6 months after atherectomy or earlier if ischemia appeared. Restenosis was defined as a greater than or equal to 50% luminal narrowing or loss of greater than or equal to 50% of the initial gain. Ischemia was documented in 23 patients. Control angiogram demonstrated restenosis in 24 patients (48%). Among those 24 patients, 18 had ischemia documented during stress test or at rest, and underwent a second procedure (second atherectomy in 4, PTCA in 8 and bypass surgery in 6 patients). Neither previous procedures nor the type of vessel significantly influenced restenosis rates. CONCLUSIONS: coronary restenosis was not less frequent after directional atherectomy, than after conventional balloon angioplasty. Previous procedures or type of vessel did not influence restenosis incidence.

Adult↗
PubMed1990

Directional atherectomy. New approaches for treatment of obstructive coronary and peripheral vascular disease.

Atherectomy is defined as the controlled removal of atherosclerotic tissue from vessel walls. The directional atherectomy catheter consists of a cup-shaped cutter within a housing unit and a small balloon. It was developed to perform transluminal atherectomy for the treatment of atherosclerotic vascular disease. This new procedure was performed on 195 lesions in peripheral arteries of lower limbs in 134 procedures, and 52 lesions in coronary arteries in 50 procedures. A successful angiographic outcome was obtained in 89% of procedures and 90% of lesions in peripheral experience, and 60% of procedures and 62% of lesions in coronary experience. A higher success rate (81%) was achieved in our more recent experience with coronary atherectomy, as compared with a 42% success rate in our earlier experience. The incidence of major complications was infrequent in both peripheral and coronary experiences. In the peripheral experience, one patient had delayed occlusion that required bypass surgery, and two patients had distal embolization. In the coronary experience, one patient had acute occlusion that required emergency bypass surgery. There were no vessel perforations. Conclusively, transluminal atherectomy is a feasible, predictable, and safe procedure for the treatment of peripheral and coronary artery disease. Further studies, however, are necessary to evaluate the long-term efficacy of this new procedure.

Aged↗
PubMed1998

Acute and late clinical outcome after rotational atherectomy for complex coronary disease.

Rotational atherectomy is effective acutely in treating complex coronary disease, but less is known about its long-term clinical outcome. We examined the acute results and late clinical outcome in 178 patients undergoing treatment with this device. Rotational atherectomy was used to treat 240 lesions in 178 individual patients. Nineteen percent had multilesion or staged multivessel procedures, and 71% had AHA-ACC Type B2/C lesions. The procedure was completed successfully in 94% of patients. Major complications occurred in 6% (death 1%, Q-MI 2.8%, and emergency bypass surgery 2.2%). Clinical follow-up was available for 167 (94%) patients at 13+/-6 months. Thirty-five percent required additional catheterization because of recurrent symptoms or an abnormal stress test. Clinical restenosis was confirmed in 18%, and an additional 2.2% of patients had progression of disease in previously untreated segments. At the end of 1 year, 14% had undergone repeat target vessel revascularization. Cumulatively at follow-up, approximately 80% had avoided an acute major complication and repeat revascularization for restenosis. Rotational atherectomy provides excellent acute and good late clinical results. At 1 year follow-up, the likelihood of developing clinical restenosis or significant progression of disease was 1 in 5, and patients had a 1 in 7 chance of requiring revascularization because of restenosis. These findings are encouraging and indicate that rotational atherectomy can be performed safely and with a high degree of acute and late clinical success in complex coronary disease characterized by multivessel or multilesion involvement and a predominance of B2 and C lesions.

Aged↗
PubMed2000

Coronary rotational atherectomy via transradial approach: a study using radial artery intravascular ultrasound.

The use of coronary rotational atherectomy via radial artery (RA) has been limited because of the large diameter of guiding catheters. We studied the feasibility of this approach by sizing the RA by intravascular ultrasound (IVUS) and using 7 Fr (2.31 mm) guiding catheters. Seventeen transradial percutaneous transluminal coronary rotational atherectomy (PTCRA) procedures were performed in 16 patients, mean age 62 +/- 12 years, for a total of 19 vessels treated. The mean RA diameter was 2.9 +/- 0.36 mm and the mean reference diameter of the treated coronary vessels was 2.7 +/- 0.45 mm. The mean coronary percent stenosis was 74% +/- 10%, the mean minimum lumen diameter was 0.76 +/- 0.35 mm, and the mean lesion length was 16 +/- 19 mm. Ten vessels were treated with rotational atherectomy alone, or with adjunctive high pressure balloon angioplasty, achieving an acute lumen gain of 0.8 +/- 0.4 mm (P = 0. 001). Nine arteries had stent implantation in addition to rotational atherectomy, resulting in an acute lumen gain of 2.4 +/- 0.5 mm (P = 0.001). The success rate was 94%. There were no vascular complications. Two patients had a non-Q myocardial infarction. In conclusion, transradial PTCRA when used in conjunction with IVUS of the RA is a safe and feasible procedure in selected cases. This may be an alternative approach of revascularization technique especially for patients with limited vascular access and for those who require early ambulation or early discharge from the hospital.

Aged↗