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PubMed2003

Initial experience with a new 8 French-compatible directional atherectomy catheter: immediate and mid-term results.

The purpose of this study was to evaluate the safety and efficacy of the new Fox Hollow atherectomy device (FHT) designed for more efficient and easier plaque removal. The FHT has short rigid section and low-profile cutter mounted on a monorail catheter. The FHT catheter was utilized in 77 patients with 98 lesions. Mean reference vessel diameter was 2.75 +/- 0.51 mm. Successful atherectomy with tissue retrieval was performed in 94 lesions (96%). Following atherectomy, mean diameter stenosis was reduced from 71.1% to 31.9% and further to 10.4% following adjunctive treatment. Angiographic complications were one coronary perforation and one adventitial staining, both successfully treated with prolong balloon inflation and stent implantation. Nine patients (11.7%) had in-hospital non-Q-wave myocardial infarction (MI). One patient died (1.3%) for noncardiac reasons and one had MI (1.3%) at 6-month follow-up. Target lesion revascularization was required in 13 (13.8%) lesions and target vessel revascularization in 15 (20.3%) patients. There was target vessel failure in 17 (23.0%) patients. Plaque debulking with the FHT catheter can be performed safely and effectively in relatively small vessels and complex lesions located in mid-distal artery segments with 6-month clinical outcome similar to prior atherectomy devices.

Aged↗
PubMed2001

Long-term outcome of patients with proximal left anterior descending coronary artery in-stent restenosis treated with rotational atherectomy.

Once a first interventional procedure has failed, patients with proximal left anterior descending in-stent restenosis are frequently sent for surgical revascularization. Data on long-term outcome in selected patients with proximal left anterior descending in-stent restenosis treated with RA are lacking. The study's objective was to evaluate the long-term outcome of patients with proximal left anterior descending artery in-stent restenosis treated with rotational atherectomy. The study population is constituted by 42 patients with proximal left anterior descending in-stent restenosis treated with rotational atherectomy. Patients were followed up for 2.1 +/- 0.9 years (range, 6--54). Restenosis length was 16.5 +/- 9.2 mm, and restenosis was diffuse (> 10 mm in length) in 30 (71.4%). The rotational atherectomy procedure was guided by intravascular ultrasound in 18 patients (42.9%). Maximum burr/artery ratio was > 0.7 in 24 (57.1%) patients. One patient suffered a periprocedural non--Q-wave infarction, but no deaths, Q-wave infarction, or new target vessel revascularization occurred during hospitalization. There were no deaths or myocardial infarctions after discharge. Sixteen patients (38.1%) needed a new revascularization, but only five (11.9%) underwent coronary bypass grafting at the end of the follow-up (2.1 +/- 0.9 years). The rate of surgical revascularization at 6 months, 1 year, and 3 years was 4.8%, 7.4%, and 18.4%, respectively. The rate of new target vessel revascularization at 6 months, 1 year, and 3 years was 16.7%, 36.5%, and 40.5%, respectively. Patients with < or = 5 months since stent implantation had a significantly higher rate of new target vessel revascularization. Patients with proximal left anterior descending in-stent restenosis may be safely treated with rotational atherectomy. This strategy is associated with a very good long-term outcome, with few patients undergoing surgical revascularization.

Adult↗
PubMed1994

Directional atherectomy with the Omnicath: a unique new catheter system.

Omnicath is a directional atherectomy catheter that employs deflecting nontraumatizing wires to anchor the cutting window at the atherectomy site. This anchoring system regulates the depth of cut and provides directional control and distal perfusion. The system continuously removes debris through a suction port from the operative site. To demonstrate the performance of the device, the Omnicath was tested in the external iliac arteries of ten atherosclerotic Hanford miniature swine in which concentric and eccentric lesions were induced. Five animals were sacrificed 3 days after atherectomy; the remaining five animals were sacrificed 6 weeks after the procedure. The acute histology demonstrates depth of cuts varying from partial plaque removal to near full thickness removal of the arterial wall. Histologic sections of the 6 week follow-up group demonstrated minimal healing response. The anchoring wires did not induce either acute injury or neointimal proliferation in the 6 week follow-up period. In conclusion, the Omnicath permits effective and safe atherectomy in this investigative model.

Animals↗
PubMed1995

Guidewire transection during rotational coronary atherectomy due to guide catheter dislodgement and wire kinking.

Rotational coronary atherectomy is an effective treatment for calcified ostial lesions. We report a case of guidewire transection during rotational atherectomy of a right coronary artery ostial stenosis. Guide catheter dislodgement appeared to have caused prolapse and kinking of the guidewire. Advancement of the burr over the kinked wire resulted in transection. The wire fragment was retrieved successfully using an inflated fixed-wire balloon catheter. This report illustrates the importance of excellent coaxial guide catheter alignment with rotational atherectomy and suggests that operators be vigilant to possible damage to the radiolucent rotational atherectomy guidewire.

Aged↗
PubMed1995

Influence of adjunctive balloon angioplasty on coronary blood flow after rotational atherectomy.

Rotational atherectomy is being performed with increasing frequency in a distinct subset of patients whose lesion characteristics are unfavorable for conventional balloon angioplasty. Although satisfactory luminal enlargement can be accomplished with the use of rotational atherectomy alone in some patients, adjunctive balloon angioplasty is necessary in most patients, to obtain a minimal residual angiographic result. To demonstrate responses associated with rotational atherectomy results, serial coronary blood flow measurements were obtained in a patient undergoing rotational atherectomy for unstable angina. Adjunctive balloon angioplasty resulted in normalization of post-stenotic coronary flow reserve. Recanalization by rotablator alone may not normalize coronary flow despite a satisfactory angiographic result.

Aged↗
PubMedDate not supplied

Animal evaluation of the prototype omnicath atherectomy catheter.

A prototype directional atherectomy catheter (Omnicath) was evaluated in four Yucatan microswines. Atherectomy was performed on iliac or aortic target lesions. After control angiography, the animals were sacrificed and the target arteries were examined histologically. Atherectomy resulted in arterial ruptures in three cases, and the track of the blade was measured to be of an average depth of 0.38 mm. Maneuverability was satisfactory but aspiration was not efficient. Precise localization of the atherectomy window was difficult. We conclude that modification of the catheter seems mandatory before use in humans.

Animals↗
PubMed1995

Three-dimensional intravascular ultrasound assessment of plaque volume after successful atherectomy.

The primary purpose of directional coronary atherectomy is the removal of intraluminal plaque. Angiography allows assessment of residual lumen narrowing but is limited in the assessment of residual plaque burden. Intravascular ultrasound has proven useful in assessing plaque size, but current use has been limited to a single, representative cross-sectional image rather than an evaluation of the entire plaque volume. To determine the volume of residual plaque after angiographically successful directional coronary atherectomy ( < or = 20% residual stenosis), we performed intravascular ultrasound in 19 patients before and after atherectomy. Only coronary lesions optimal for three-dimensional analysis (a single, discrete stenosis in a nontortuous, noncalcified native coronary artery) were selected. A 2.9F sheath-design intravascular ultrasound catheter with a motorized pullback device was used in all patients. The cross-sectional area of the artery (defined by the medial-adventitia border), the lumen, and the plaque were measured at 1 mm intervals over a 15 to 20 mm segment, which included the target lesion and a proximal reference segment (n = 362 cross-sections), before and after atherectomy. The volumes of the artery, vessel lumen, or plaque were calculated with a modified Simpson's equation and compared with standard area measurements at the point of maximal stenosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

Coronary artery morphologic features after coronary rotational atherectomy: insights into mechanisms of lumen enlargement and embolization.

The coronary arteries and myocardium from two patients who died after coronary rotational atherectomy were analyzed to gain insights into the mechanisms of lumen enlargement and to document embolization of calcified plaque. Rotational atherectomy resulted in sharp cuts in plaque, producing a relatively smooth luminal surface. When extensive nodular calcific atherosclerosis was present, the luminal surface was focally uneven with exposure of jagged calcified plaque to blood flow. Deep plaque fissures and medial dissections were also seen. These fissures may have been created by the rotoblator or by adjunctive balloon angioplasty. Multiple calcific atheroemboli were present after rotoblator use in plaques containing extensive nodular calcification; in moderately calcified plaque only one small atheroembolus was found. Thus embolization of calcified plaque can occur after rotational atherectomy and may correlate with the severity of plaque calcification. Rotational atherectomy produces a focally smooth, sharp-edged, luminal surface, a lumen enlargement mechanism different from balloon angioplasty.

Aged↗
PubMed1993

Rotational coronary atherectomy after unsuccessful coronary balloon angioplasty.

The clinical and angiographic outcome of patients undergoing rotational coronary atherectomy after unsuccessful balloon angioplasty was evaluated using quantitative angiographic methods to provide insight into this procedure's mechanism of benefit. During the study period, 41 patients (50 lesions) were referred for rotational atherectomy after standard balloon angioplasty was unsuccessful. After rotational atherectomy, percent diameter stenosis was reduced from 72 +/- 14% to 41 +/- 16% (p < 0.001); adjunct balloon angioplasty was performed in 44 lesions (88%), resulting in a 25 +/- 17% final diameter stenosis (p < 0.001). The acute gain in minimal lumen diameter was 1.20 +/- 0.59 mm. In lesions needing adjunct balloon dilatation, lesion stretch was 73 +/- 27%, and elastic recoil was 22 +/- 18%, with no variation by etiology of the initial balloon failure. Overall angiographic success (< 50% residual diameter stenosis) was obtained in 49 lesions (98%). Procedural success, defined as < 50% residual diameter stenosis and the absence of major in-hospital complications (death, Q-wave myocardial infarction or emergency bypass surgery), was obtained in 37 of 41 procedures (90%); complications developed in 3 patients (7%), including 2 who needed emergency bypass surgery after development of delayed abrupt closure. It is concluded that rotational coronary atherectomy may be used in selected patients when standard balloon angioplasty is unsuccessful. Its mechanism of benefit appears related, at least in part, to changes in plaque compliance resulting from partial atheroma ablation.

Angioplasty, Balloon, Coronary↗
PubMed1994

Acute and long-term outcome of directional coronary atherectomy for stable and unstable angina.

The clinical efficacy and safety of directional coronary atherectomy for the treatment of stable and unstable angina were assessed in 82 patients with stable and 68 patients with unstable angina. Therefore, clinical and angiographic follow-up was obtained in a prospectively collected consecutive series of 150 atherectomy procedures. Restenosis was assessed clinically and by quantitative angiography. The overall clinical success rate of atherectomy for patients with unstable and stable angina was 88% and 91%, respectively. No significant differences were found for in-hospital event rates between the unstable and stable angina groups: death (1.5% vs 0%), myocardial infarction (10% vs 6%), and emergency bypass operation (3% vs 2%). These clinical events were related to the occurrence of abrupt occlusions (8.8% in patients with stable and 6.1% in those with unstable angina; p = NS). Clinical follow-up was achieved in 100% of the patients with stable and unstable angina at a mean interval of 923 and 903 days, respectively. Two-year survival rates were 96% and 97% in the populations with unstable and stable angina, respectively. There were no significant differences with respect to bypass surgery and angioplasty, but event-free survival at 2 years was significantly lower in the unstable (54%) than the stable (69%) angina group. Quantitative coronary angiography did not detect any difference in luminal renarrowing during the 6-month angiographic follow-up period. Although directional coronary atherectomy can be performed effectively in patients with unstable and stable angina, the long-term clinical outcome was less favorable in the unstable angina group.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1994

Peripheral vascular complications of directional coronary atherectomy and stenting: predictors, management, and outcome.

The hospital course of 688 patients consecutively treated with directional coronary atherectomy (375 procedures) or Palmaz-Schatz stenting (376 procedures) was evaluated to identify incidence, predictors, and outcome of major vascular complications. Major vascular complications (defined as surgical repair, major hematoma, or bleeding with a > 10-point hematocrit decrease requiring transfusion alone, or nonsurgically managed arteriovenous fistula, pseudoaneurysm, retroperitoneal hematoma or femoral neuropathy) occurred in 11.7% of procedures, and were more common after stenting than after directional coronary atherectomy (16.8% vs 6.7%, p < 0.001). In particular, surgical repair was required after 10.1% of stenting procedures, versus 5.1% of directional coronary atherectomies (p < 0.02). Multivariable analysis identified age > 70 years, coronary stenting, female gender, multiple procedures during the index hospitalization, and a low nadir platelet count as independent predictors of major vascular complications (all p < 0.03). In the stent subgroup, excessive anticoagulation, nadir platelet count, hypertension, and sheath removal protocol (other than a same-day, activated clotting time-guided protocol) were all independent predictors of vascular complications. Thus, the overall risk of vascular complications with new device procedures (stenting, directional atherectomy) is greater than that traditionally seen with balloon angioplasty alone, and is determined by patient-related factors, procedure type, and management parameters.

Aged↗
PubMed1992

Relation of deep arterial resection and coronary artery aneurysms after directional coronary atherectomy.

OBJECTIVES: The aims of this study were to document the frequency of coronary artery aneurysm formation in patients undergoing directional coronary atherectomy and to determine the relation of such aneurysms to the depth of arterial resection. BACKGROUND: Deep arterial injury is relatively frequent with the use of directional coronary atherectomy, but the potential for subsequent coronary artery aneurysm formation is unknown. METHODS: Results in a consecutive series of 64 successfully treated patients (a total of 69 lesions; mean angiographic follow-up at 5 months) treated with directional coronary atherectomy were retrospectively analyzed with use of quantitative angiographic and histologic data. RESULTS: Coronary aneurysms (ratio of dilated vessel segment to the adjacent reference segment > 1.2:1) occurred in seven patients (10%). The only significant clinical correlate of aneurysm formation was a relatively shorter duration of angina. There were no significant preprocedural angiographic predictors of aneurysms, although 6 (86%) of the 7 aneurysmal lesions arose from restenosis lesions compared with 30 (48%) of 62 lesions with no subsequent aneurysm development (p = 0.06). Histopathologic examination of 414 specimens from 68 treated lesions showed no significant difference in the occurrence of subintimal resection (media +/- adventitia) between those with and without subsequent aneurysm (29% vs. 22%). Media alone was found in 14% of specimens from lesions that later became aneurysmal versus 15% of those that did not; adventitial resection was found in 14% and 7% of specimens, respectively (p = 0.08), with relatively more adventitia per specimen from those with aneurysm (55% vs. 30% without aneurysm, p = 0.08). CONCLUSIONS: Aneurysms occur relatively frequently after directional coronary atherectomy. Although there was no statistically significant correlation with the depth of arterial resection, the evidence from this study suggests that the role of adventitial resection in the occurrence of late aneurysm development should be explored further.

Aged↗
PubMed1993

Generalized model of restenosis after conventional balloon angioplasty, stenting and directional atherectomy.

OBJECTIVES: This study was designed to extend the results of a quantitative model originally developed for restenosis after stenting or atherectomy to include restenosis after conventional balloon angioplasty. BACKGROUND: We have previously described a continuous regression model that explains late (6-month) lumen narrowing as the difference between the immediate gain and the subsequent normally distributed late loss in lumen diameter after Palmaz-Schatz stenting or directional atherectomy. METHODS: Lumen diameter was measured immediately before and after coronary intervention on 524 consecutive lesions including those treated by Palmaz-Schatz stenting (102), directional atherectomy (134) and conventional balloon angioplasty (288). Of these lesions, 475 (91%) underwent follow-up angiography 3 to 6 months after treatment. The immediate increase in lumen diameter produced by the intervention (immediate gain) and the subsequent reduction in lumen diameter between the time of intervention to follow-up angiography (late loss) were examined. Association between demographic or angiographic variables and continuous measures of restenosis (late lumen diameter or late percent stenosis) was tested with linear regression techniques; a traditional binary measure of restenosis (late diameter stenosis > or = 50%) was evaluated with logistic regression analysis. RESULTS: Regression models relating late lumen diameter to the immediate lumen result were successfully fitted to all segments studied. According to these models, three indexes of restenosis (late lumen diameter, late percent stenosis and binary restenosis) were found to depend solely on the immediate lumen diameter after the procedure and the immediate residual percent stenosis, but not on the specific intervention used. Moreover, the late loss in lumen diameter was found to vary directly with the immediate gain provided by an intervention, and the "loss index" (a measure that corrects for differences in immediate gain) was uniform among all three interventions. CONCLUSIONS: The quantitative model originally developed for restenosis after stenting or atherectomy may thus be generalized to include conventional balloon angioplasty. It shows that the apparent differences in restenosis among the three interventions studied are due solely to differences in the immediate result provided and not to differences in the behavior of subsequent late loss. Moreover, although the late loss in lumen diameter was found to correlate with differences in the immediate gain provided by an intervention, the "loss index" (a measure that corrects for differences in acute gain) was uniform across all three interventions. It is thus the immediate result (and not the procedure used to obtain that result) that determines late outcome after coronary intervention.

Aged↗
PubMed1995

Multivariate predictors of intravascular ultrasound end points after directional coronary atherectomy.

OBJECTIVES: This study attempted to identify the clinical, angiographic, procedural and intravascular ultrasound predictors of directional atherectomy results assessed by intravascular ultrasound. BACKGROUND: Several angiographic and intravascular ultrasound variables have been associated with the outcome of directional coronary atherectomy. No study has incorporated both modalities into a predictive model. METHODS: One hundred seventy patients were analyzed using preintervention and postintervention intravascular ultrasound and quantitative angiography. Clinical and procedural variables were collected by independent chart review. Quantitative and qualitative angiographic analysis was performed by a core laboratory in blinded manner. Intravascular ultrasound was performed using a transducer-tipped catheter, rotating within a stationary imaging sheath, and withdrawn automatically at 0.5 mm/s. Clinical, procedural, angiographic and ultrasound variables were tested in a multivariate linear regression model. Dependent ultrasound variables included postatherectomy lumen cross-sectional area and percent cross-sectional narrowing (plaque plus media/external elastic membrane cross-sectional area) and, in a subgroup of 47 patients studied using volumetric analysis, percent plaque volume removal. RESULTS: By multivariate stepwise linear regression analysis, predictors of residual lumen cross-sectional area (correcting for reference lumen area) included arc of calcium and preatherectomy plaque plus media cross-sectional area; predictors of residual cross-sectional narrowing were arc of calcium, preatherectomy plaque plus media cross-sectional area and lesion length; and predictors of percent plaque volume removal were arc of calcium and atherectomy device size. CONCLUSIONS: The preintervention lesion arc of calcium measured by intravascular ultrasound is the most consistent predictor of the effectiveness and results of directional coronary atherectomy.

Atherectomy, Coronary↗
PubMed1994

Rotational atherectomy multicenter registry: acute results, complications and 6-month angiographic follow-up in 709 patients.

OBJECTIVES: The purpose of this study was to describe data collected for an industry-sponsored multicenter registry of rotational atherectomy. BACKGROUND: Several new devices are in use or under development for coronary atherectomy. The clinical role for each is in part defined by descriptive registry data. METHODS: We describe results in 709 consecutive patients undergoing 743 procedures representing 874 lesions. The majority of lesions were in the left anterior descending coronary artery. Lesion morphology was described as eccentric (61.1%), calcified (32%), tortuous (26.6%) and long (24.9%), with previous intervention in 32.7%. RESULTS: Overall procedural success rate, including lesions treated with rotational atherectomy alone and with balloon angioplasty was 94.7% and did not vary between lesion type, location, characteristics or severity. Previously treated lesions had a significantly higher success rate (97.4%, p = 0.04) than new lesions. Major complications, including death 0.8% (95% confidence interval [CI] 0.3% to 1.7%), Q wave myocardial infarction 0.9% (95% CI 0.4% to 1.9%) and emergent coronary artery bypass surgery 1.7% (95% CI 0.9% to 3.0%), were similar to other reported devices and were associated with length and number of lesions treated. Non-Q wave myocardial infarction occurred in 3.8% of patients and was significantly associated with female gender and history of previous myocardial infarction. Abrupt occlusion occurred in 3.1% of patients and was significantly associated with bifurcated lesions and the use of adjunctive therapy. Angiographic evidence of dissection was seen in 10.5% (95% CI 8.3% to 12.7%) of patients and was significantly associated with more complex lesions, such as eccentric, long, calcified and American College of Cardiology/American Heart Association type C lesions. Overall restenosis rate was 37.7%, determined with 6-month angiography, representing 64% of treated lesions. Higher restenosis rates were associated only with poorer initial treatment outcome, diabetes and lower follow-up angiographic rate per reporting center. CONCLUSIONS: Rotational atherectomy appears to be a safe method of treatment with a high success rate in a broad spectrum of lesion types, with restenosis rates similar to other techniques. Further conclusions will require randomized trials.

Aged↗
PubMed1994

Directional coronary atherectomy in unstable angina.

OBJECTIVES: To determine whether excision of complex, ulcerated plaque improves the risk of patients with unstable angina to the level of those with stable angina, the results of directional coronary atherectomy were compared in patients with these two syndromes. BACKGROUND: The procedural results of angioplasty in the setting of unstable angina are not as favorable as those observed for chronic stable angina, presumably because thrombus-associated plaque augments the risk of abrupt closure. METHODS: Two hundred eighty-seven consecutive patients who had undergone directional atherectomy for a single new stenosis were studied. Seventy-seven patients had stable angina (Group I); 110 patients had progressively worsening angina in the absence of rest or postinfarction angina (Group II); and 100 patients had rest or postinfarction angina, or both (Group III). RESULTS: Major ischemic complications (death, Q wave infarction, emergency bypass surgery) occurred more frequently in Group III (1.3% [Group I] vs. 0.9% [Group II] vs. 7% [Group III], p = 0.036). This difference was largely due to a higher incidence of emergency surgery in Group III (1.3% [Group I] vs. 0% [Group II] vs. 5% [Group III], p = 0.05). Clinical follow-up was obtained in 97% of successful procedures for a mean follow-up period of 22 months (range 9 to 52) and revealed a higher incidence of hospital admission for angina (p = 0.05) and a trend toward more bypass surgery (p = 0.09) and myocardial infarction (p = 0.16) in Group III. There was no difference in repeat percutaneous interventions among the three groups (range 19% to 24%, p = 0.75). CONCLUSIONS: These results show that the definition of unstable angina is important in determining the immediate outcome of directional atherectomy. In the absence of rest or postinfarction angina, the immediate results are not significantly different from those obtained in stable angina. Our results also suggest that both the immediate and short-term outcome in unstable angina are not greatly influenced by atherectomy but more so by the pathophysiology of unstable angina, which increases the complications of percutaneous interventions.

Analysis of Variance↗
PubMed1995

Characteristics and consequences of myocardial infarction after percutaneous coronary intervention: insights from the Coronary Angioplasty Versus Excisional Atherectomy Trial (CAVEAT).

OBJECTIVES: We examined the results of the Coronary Angioplasty Versus Excisional Atherectomy Trial (CAVEAT) to determine the characteristics and consequences of creatine kinase (CK) and creatine kinase, MB myocardial isoenzyme fraction (CK-MB) elevations after percutaneous coronary intervention. BACKGROUND: Enzyme elevations after interventional procedures have usually been thought to be without long-term clinical consequences. However, recent preliminary reports have suggested that there are important long-term clinical sequelae in patients with even mild enzyme elevations after coronary procedures. METHODS: Patients with new native lesions undergoing coronary intervention at 35 clinical sites were randomized to undergo percutaneous coronary angioplasty (n = 500) or directional coronary atherectomy (n = 512). Cardiac enzyme levels were measured 12 and 24 h after the interventional procedure and when clinically indicated for recurrent myocardial ischemia. Enzyme profiles were analyzed using a ratio that compared the peak enzyme level and the local laboratory upper limit of normal. Standard 12-lead electrocardiograms (ECGs) recorded before and after the procedure were interpreted by two independent readers who had no knowledge of the randomization data. Postprocedural myocardial infarction was defined as the appearance of new Q waves on the ECG, CK-MB levels three or more times the upper limit of normal or a total CK concentration two or more times the upper limit of normal when CK-MB levels were unavailable. Regression models were used to evaluate the predictive significance of a postintervention myocardial infarction with respect to clinical outcomes at 30 days and 1 year. RESULTS: There were 78 myocardial infarctions in the atherectomy group and 34 in the angioplasty group (15.2% vs. 6.8%, p = 0.001). Patients with a myocardial infarction more often had a repeat intervention or emergency coronary artery bypass surgery. Hospital length of stay was increased among patients with an infarction, as were mean hospital costs ($17,340.65 vs. $11,308.47, p = 0.0003). Postprocedural myocardial infarction was highly predictive of mortality, bypass surgery or repeat intervention within 30 days (p < 0.0001). CONCLUSIONS: Myocardial infarction occurred commonly after coronary intervention in CAVEAT and was associated with a worse clinical outcome. Although the incidence of myocardial infarction was higher with atherectomy than with angioplasty, the baseline characteristics and consequences of the infarctions were similar between the treatments with regard to 30-day outcome. Myocardial enzyme elevations after an otherwise successful interventional procedure may identify a population at risk for a future cardiac event.

Angioplasty, Balloon, Coronary↗
PubMed1995

Coronary angioplasty, atherectomy and bypass surgery in cardiac transplant recipients.

OBJECTIVES: This study sought to analyze the outcomes of revascularization procedures in the treatment of allograft coronary disease. BACKGROUND: Allograft vasculopathy is the main factor limiting survival of heart transplant recipients. Because no medical therapy prevents allograft atherosclerosis, and retransplantation is associated with suboptimal allograft survival, palliative coronary revascularization has been attempted. METHODS: Thirteen medical centers retrospectively analyzed their complete experience with percutaneous transluminal coronary angioplasty, directional coronary atherectomy and coronary bypass graft surgery in allograft coronary disease. RESULTS: Sixty-six patients underwent coronary angioplasty. Angiographic success (< or = 50% residual stenosis) occurred in 153 (94%) of 162 lesions. Forty patients (61%) are alive without retransplantation at 19 +/- 14 (mean +/- SD) months after angioplasty. The consequences of failed revascularization were severe. Two patients sustained periprocedural myocardial infarction and died. Angiographic restenosis occurred in 42 (55%) of 76 lesions at 8 +/- 5 months after angioplasty. Angiographic distal arteriopathy adversely affected allograft survival. Eleven patients underwent directional coronary atherectomy. Angiographic success occurred in 9 (82%) of 11 lesions. Two periprocedural deaths occurred. Nine patients are alive without transplantation at 7 +/- 4 months after atherectomy. Bypass graft surgery was performed in 12 patients. Four patients died perioperatively. Seven patients are alive without retransplantation at 9 +/- 7 months after operation. CONCLUSIONS: Coronary revascularization may be an effective palliative therapy in suitable cardiac transplant recipients. Angioplasty has an acceptable survival in patients without angiographic distal arteriopathy. Because few patients underwent atherectomy and coronary bypass surgery, assessment of these procedures is limited. Angiographic distal arteriopathy is associated with decreased allograft survival in patients requiring revascularization.

Adolescent↗