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At least 217 records · Page 12Linked to original sources
PubMed2006

Long-term results after directional atherectomy of femoro-popliteal lesions.

OBJECTIVES: Our objective in this research was the evaluation of the long-term results after directional atherectomy using the Silverhawk device (FoxHollow Technologies, Redwood City, California) of femoro-popliteal lesions. BACKGROUND: Considering reports on stent fractures in femoro-popliteal arteries, atherectomy may be a valuable alternative to stenting. METHODS: Eighty-four patients with 100 legs and 131 lesions with peripheral occlusive disease Rutherford categories 2 to 5 were included in a prospective registry. Forty-five lesions were de novo lesions (group 1; 34%), 43 lesions native vessel restenoses (group 2; 33%), and 43 lesions in-stent restenoses (group 3; 33%). Additional low pressure balloon angioplasty was used in 78 of 131 lesions (59%) and stenting in 8 lesions (6%). RESULTS: Technical success rate was 86% for atherectomy only and 100% after additional therapy. Mean lesion length was 43 +/- 54 mm, 105 +/- 122 mm, and 131 +/- 111 mm for group 1, group 2, and group 3, respectively (p < 0.001). Primary patency, defined as freedom of a >50% restenosis detected by duplex, was 84%, 54%, and 54% at 12 months (p = 0.002) and 73%, 42%, and 49%, at 18 months (p = 0.008); secondary patency rates were 100%, 93%, and 91% at 12 months (p = NS) and 89%, 67%, and 79% at 18 months (p = 0.001), respectively; and target lesion revascularization rate was 16%, 44%, and 47% at 12 months and 22%, 56%, and 49% at 18 months (p = 0.003 each) for group 1, group 2, and group 3, respectively. The only independent predictor for restenosis was treatment of restenotic lesions. Ankle-brachial index was significantly improved after 12 months and 18 months in all groups. CONCLUSIONS: Long-term technical and clinical results after directional atherectomy of femoro-popliteal lesions are in favor of de novo lesions compared with restenotic lesions.

Adult↗
PubMed1996

Optimal burr and adjunctive balloon sizing reduces the need for target artery revascularization after coronary mechanical rotational atherectomy.

We analyzed the effect of differing burr and balloon sizes during mechanical rotational atherectomy on the need for target vessel revascularization at 6 months. The ideal burr/artery ratio and adjunctive balloon/artery ratio for optimizing acute luminal results and minimizing restenosis is unknown. Six-month clinical follow-up was obtained in 311 patients (339 lesions) treated with rotational atherectomy from August 1993 to September 1994, to determine whether procedural results or technique were related to the need for target vessel revascularization. Target vessel revascularization, defined as repeat percutaneous intervention or bypass surgery within 6 months after rotational atherectomy, occurred in 19% of patients. Larger burr/artery ratios, defined as the final burr size divided by the reference artery size, were correlated with decreased postatherectomy diameter stenosis (p <0.009) and decreased final diameter stenosis (p <0.03). However, there was no statistical association between postatherectomy or final diameter stenosis with need for revascularization (p = not significant [NS]). The need for revascularization was lowest for burr/artery ratio between 0.6 to 0.85 (15%) versus burr/artery <0.6 or >0.85 (25%) (p <0.04). Postatherectomy, smaller balloon/artery ratios, defined as the final balloon size divided by the reference artery size, were correlated with lower repeat revascularization rates. Balloon/artery ratios <0.95 (target vessel revascularization = 11% vs 25% in balloon/artery >0.95) were associated with the best luminal results and the least risk for clinical restenosis (p <0.006). For rotational atherectomy, despite improvement in acute luminal results with increased burr/artery ratio, the use of a moderate burr/artery ratio correlated with the lowest revascularization rates. There was no correlation between postatherectomy or final diameter stenosis and need for repeat interventions. However, the use of large balloon/artery ratios after rotablator was associated with higher target vessel revascularization rates.

Aged↗
PubMed2000

Effectiveness of rotational atherectomy of right coronary artery ostial stenosis.

Balloon angioplasty and stenting of right coronary ostial stenosis may frequently be impeded by lesion calcification, whereas rotational atherectomy, which ablates calcified plaque, should treat these lesions effectively. Accordingly, we evaluated procedural success and longterm clinical outcome of rotational atherectomy of right coronary ostial stenosis. Procedural data were obtained from a comprehensive interventional registry and follow-up information was obtained by chart review and patient enquiry. All patients who developed recurrent angina underwent angiographic restudy. During a 5-year interval, 119 patients underwent rotational atherectomy of right coronary ostial stenosis. Multilesion interventions were performed in 55% of patients. Ostial lesions were 3.73+/-3.69 mm in length (mean +/- SD), and 57.1% were significantly calcified. Reference vessel diameter was 3.42+/-0.56 mm. Maximum burr:artery ratio was 0.64+/-0.1 with adjunct balloon angioplasty in 89.1% and adjunct stenting in 9.2%. Procedural success (<50% residual stenosis without major complication) was 97.5%, with 1.7% uncomplicated failure and 0.8% Q-wave infarction. Maximum residual stenosis was 15+/-17%. During 6-month follow-up, available in 94% of patients, 82.7% remained angina-free, 10.9% developed recurrent angina due to right coronary ostial restenosis, and 6.4% developed recurrent angina due to another lesion. Two years after intervention, target lesion revascularization rate was 16%. Predictors of symptomatic angiographic restenosis were dissection >10 mm, final minimal luminal diameter <2.5 mm, lesion length >10 mm, restenotic lesion, and diabetes. We conclude that rotational atherectomy of right coronary ostial stenosis results in excellent acute procedural success and in low incidence of clinical recurrence, with a high proportion of patients remaining angina-free 2 years after intervention.

Aged↗
PubMed1994

Determinants of patency after percutaneous angioplasty and atherectomy of occluded superficial femoral arteries.

BACKGROUND: Patients undergoing percutaneous recanalization of chronically occluded superficial femoral arteries were studied to determine which factors correlated with 1-year patency. Immediate change in ankle:brachial index (ABI), length of occlusion, tibial run-off, and the performance of supplemental catheter atherectomy were evaluated. METHODS: Eligible patients had at least one patient tibial run-off vessel and the absence of limb-threatening ischemia. Recanalization was performed via passage of a guidewire followed by balloon angioplasty. Tibial run-off was scored based on a modification of the angiogram scoring system of the Society for Vascular Surgery and the International Society for Cardiovascular Surgery. Supplemental transcutaneous extraction catheter atherectomy was randomly assigned to a sub-group of patients after initial experience with the recanalization technique. Clinical follow-up was employed to determine patency. RESULTS: Forty-two of 57 attempts (74%) at recanalization were immediately successful. Overall 1-year patency was 40% in 40 limbs that could be followed. In limbs with balloon angioplasty alone (n = 23), patency was 43% compared with 35% in those having supplemental atherectomy. Tibial run-off did not vary significantly between patent and occluded groups. When ABI increased by 0.3 or more, patency was 56% compared with 26% when the ABI increase was less than or equal to 0.1 (P = 0.13). Occlusion length averaged 18.1 +/- 10.6 cm for all limbs and did not vary significantly between early successes and failures. Limbs with short occlusions (less than or equal to 5 cm, n = 8) had 63% patency compared with 38% patency for limbs with long occlusions (greater than 25 cm, n = 16), but the difference was not significant by analysis of variance. CONCLUSIONS: An initial change in ABI was most predictive for patency, whereas no correlation with tibial run-off was demonstrated. Atherectomy did not increase patency. Short occlusions were more likely to remain patent than long ones, but overall patency was lower than described in other series.

Analysis of Variance↗
PubMed2000

Replication in restenotic atherectomy tissue.

Previously, we demonstrated that replication in restenotic coronary atherectomy specimens was an infrequent and modest event. In general, this data was interpreted with caution, as immunocytochemistry for the proliferating cell nuclear antigen (PCNA) was used to subjectively assess proliferation and most of the tissue specimens were resected more than 3 months after the initial interventional procedure. The purpose of the present study was to use a more sensitive method of detecting replication, in situ hybridization for histone 3 (H3) mRNA, to determine the replication profile of human directional atherectomy specimens. Restenotic directional coronary atherectomy specimens from lesions that had undergone an interventional procedure within the preceding 3 months were studied. In addition, larger atherectomy specimens from peripheral arterial lesions were assessed to ensure that pockets of replication were not being overlooked in the smaller coronary specimens. We found evidence for replication in tissue resected from 2/17 coronary and 9/12 peripheral artery restenotic lesions. In contrast, 3/11 specimens resected from primary lesions of peripheral arteries also expressed H3 mRNA. We estimated that the maximum percentage of cells that were replicating in restenotic coronary, restenotic peripheral and primary peripheral artery tissue slides to be <0.5, < or =1.2 and <0.01%, respectively. Replication was found in tissue specimens resected both early and late after a previous interventional procedure. For specimens with >15 replicating cells per slide we found high levels of focal replication. Therefore, cell replication, as assessed by the expression of H3 mRNA, was infrequent in restenotic coronary artery specimens, whereas peripheral restenotic lesions had more frequent and higher levels of replication regardless of the interval from the previous interventional procedure. For all specimens the percentage of cells that were replicating was low, however focal areas with relatively high replication indices were presented. Although replication was more abundant in restenotic lesions it does not appear to be a dominant event in the pathophysiology of restenosis.

Adult↗
PubMed1994

Immediate and long-term outcome after directional coronary atherectomy: analysis of gender differences.

OBJECTIVE: To compare the short-term and long-term outcomes of directional coronary atherectomy in women and men. DESIGN: We retrospectively analyzed 291 consecutive directional atherectomy procedures performed in 61 women and 230 men at the Mayo Clinic between October 1988 and November 1992. MATERIAL AND METHODS: The baseline clinical and angiographic characteristics, including extent of coronary artery disease and left ventricular ejection fraction, were compared for the male and female patients, and the short-term and long-term complications associated with atherectomy were summarized on the basis of gender. RESULTS: At baseline, women were older than men (67 +/- 12 versus 61 +/- 11 years; P = 0.001), and more women than men had class III or IV angina (90% versus 64%; P < 0.001); slightly more women than men had rest pain (64% versus 52%). Overall clinical success (improvement in luminal diameter of 40% or more and no death, Q-wave myocardial infarction, or emergency coronary bypass operation) was achieved in 89% of women and 95% of men (P = 0.054). In-hospital mortality was similar in women and men (1.6% and 1.7%, respectively), but acute myocardial infarction occurred more frequently in women than in men (4.9% versus 0.4%; P = 0.03). Significant peripheral vascular complications occurred in 6.6% of women versus 0.9% of men (P = 0.02). During long-term follow-up (mean, 2.9 years), survival and freedom from recurrent angina were similar among women and men. CONCLUSION: Directional coronary atherectomy is associated with slightly lower success and a higher frequency of myocardial infarction among women than among men. The higher postprocedural rate of myocardial infarction among women may reflect their worse clinical status at time of initial assessment. Despite these observations, women and men seem to have comparable survival and freedom from recurrence of angina during extended follow-up.

Aged↗
PubMed2001

[In-hospital major complications associated with rotational atherectomy: experience with 800 patients at a single center].

INTRODUCTION: Rotational atherectomy is usually performed in patients with angiographically determined high risk coronary lesions. The aim of this study was to evaluate the rate of major adverse cardiac events (death, Q-wave infarction or new revascularization) after rotational atherectomy, as well as to identify the clinical characteristics associated with this incidence. PATIENTS AND METHODS: The study population included 800 patients treated with rotational atherectomy from 1993 to 1999: 512 (64%), for de novo lesions, and 288 (36%) for restenosis. Balloon dilation and coronary stenting was performed in 95% and 34% of patients, respectively. RESULTS: During hospitalization, 17 patients (2.1%) died, 16 (2%) had a Q-wave infarction, 30 (3.8%) a non-Q infarction, and new revascularization was performed in 28 (3.5%). The incidence of major adverse cardiac events was 6.5% (n = 52), this incidence being higher in the presence of diabetes (8.9 vs. 4.4%; p = 0.01), unstable angina or acute/recent myocardial infarction (7.6 vs. 3.3%; p = 0.02), multivessel disease (8.6 vs. 3.3%; p < 0.01), treated vessel other than right coronary (7.0 vs. 1.7%; p = 0.01), procedure in > 1 vessel (10.7 vs. 4.7%; p < 0.01), angiographic failure (62.5 vs. 5.5%; p < 0.001), and de novo lesions (8.4 vs. 2.5%; p < 0.01), with diabetes and treatment of de novo lesions being independent predictors of major adverse cardiac events. However, age, previous infarction, and left ventricular dysfunction, were not associated with the rate of events. CONCLUSION: Some simple variables are associated with a higher incidence of major adverse cardiac events after rotational atherectomy. Advanced age, previous infarction and left ventricular dysfunction, however, do not necessarily imply a poorer prognosis in these patients.

Aged↗
PubMed1998

Behavior of atherosclerotic plaque components after in vitro angioplasty and atherectomy studied by high field MR imaging.

AIMS: Using magnetic resonance imaging (MRI), we developed in vitro models to image the response of fatty, fibrous, and calcified plaques to in vitro models of angioplasty and atherectomy, and tested the resistance of collagenous cap and lipid core to radial compression. METHODS AND RESULTS: We studied the effects of balloon compression on 10 fibrous plaques with a complete collagenous cap (group A), 6 fatty plaques without cap (group B), and 5 calcified plaques (group C). Atherectomy was performed on nine other fibrous lesions (group D). In group A, fibrous cap, lipid core, and plaque did not change after radial compression despite a decrease in luminal obstruction due to medial stretching. In group B, a reduction of plaque (-30%) and lipid core (-35%) were observed. Compression dissected calcified plaques at the shoulder level. In group D, atherectomy reduced collagenous cap by 54%, and plaque by 35%. CONCLUSIONS: In these models, MRI shows 1) the high resistance of collagenous caps to radial compression, 2) a stretching effect of compression on disease-free walls, enlarging lumen in case of fibrous plaque, but a reduction and redistribution of lipid cores in case of fatty plaques, 3) the rupture of calcified arteries at the plaque shoulder, and 4) the reduction of fibrous components by atherectomy but not by angioplasty. By characterizing plaque composition, MRI may allow a predictable response of atherosclerotic arteries to interventional procedures.

Angioplasty, Balloon↗
PubMed1997

Comparison of early and recent results with rotational atherectomy.

OBJECTIVES: We compared an early registry of rotational atherectomy with a recent registry to examine the evolution of patient profiles, lesion characteristics and procedural outcomes for patients treated with rotational atherectomy. BACKGROUND: With increased experience, the selection of patients and lesions treated with a device matures. This study documents the changes in the application of rotational atherectomy. METHODS: The patient characteristics and procedural outcomes from two multicenter patient registries-Registry I: 2,953 procedures, 3,717 lesions from 1988 to 1993; and Registry II: 200 procedures, 268 lesions from 1994-were analyzed and compared. RESULTS: There was an increase in the average age of the patients (63 vs. 65 years, p < 0.02) and the proportion of patients with unstable angina (42.9% vs. 56.5%, p < 0.01) or previous coronary artery bypass graft surgery (18.8% vs. 24.5%, p < 0.05) in Registry II. Registry II included fewer left anterior descending coronary lesions (46.5% vs. 32.8%, p < 0.01), more type B and C lesions (83.1% vs. 91.8%, p < 0.01), more eccentric lesions (69.0% vs. 79.5%, p < 0.01) and more calcified lesions (50.3% vs. 69.4%, p < 0.01). Complications, including urgent bypass surgery, Q and non-Q wave myocardial infarction, dissection, acute occlusion and perforation, were similar in the two groups. However, mortality increased from 1.0% to 3.0% (p < 0.05) in Registry II. CONCLUSIONS: Comparison of recent and early patients treated with rotational atherectomy revealed an increase in the complexity of patients and lesions. Although the rate of death was increased, the overall rate of major complications was not significantly changed (4.7% vs. 6.0%, p = NS).

Aged↗
PubMed1997

Transluminal extraction catheter atherectomy followed by immediate stenting in treatment of saphenous vein grafts.

OBJECTIVES: The purpose of this study was to evaluate the effectiveness of transluminal extraction catheter (TEC) atherectomy followed by immediate Palmaz-Schatz coronary stenting of coronary bypass vein grafts. BACKGROUND: Degeneration of saphenous vein coronary bypass grafts has become a common problem. Repeat bypass surgery is associated with greater risk and a poorer outcome than the initial operation. Moreover, percutaneous interventional procedures in vein grafts have been associated with high procedural complication rates, including distal embolization, and high restenosis rates. TEC atherectomy may reduce distal embolization, and stenting may reduce restenosis rates. METHODS: We evaluated the procedural, hospital and clinical outcomes of TEC atherectomy followed by immediate Palmaz-Schatz coronary stenting of 53 vein grafts in 49 consecutive patients. The strategy was to limit instrumentation to extraction debulking and to stabilizing the site with stent deployment before using balloon dilation for optimal gain in lumen diameter. RESULTS: Results are shown as mean value (95% confidence interval [CI]). The mean graft age was 9.2 years (95% CI 7.9 to 10.5), and 1.0 (95% CI 1 to 1) TEC cutter (2.2 mm [95% CI 2.1 to 2.3]) and 1.7 (95% CI 1.4 to 2.0) Palmaz-Schatz coronary stents/ vein graft were used. The procedural success rate was 98%, with a minimal lumen diameter at baseline of 1.3 mm (95% CI 1.1 to 1.5), increasing to 3.9 mm (95% CI 3.6 to 4.2) (p < 0.05) after the TEC-stent procedure. Procedural complications occurred infrequently: graft perforation in 1 (2%) of 53 patients and distal embolization in 1 (2%) of 53 (same patient). In-hospital complications included non-Q wave myocardial infarction in two patients and death after a successful procedure in three (6%) (n = 1 each: massive bleeding from the catheter site; sepsis; and acute myocardial infarction with asystole in the distribution of the stented vessel). The event-free survival rate to hospital discharge was 90%. Clinical follow-up (13 months [95% CI 11 to 15]) was available for all patients. There were five (11%) revascularization procedures (three bypass grafts and two percutaneous transluminal coronary interventions), four (9%) nonfatal myocardial infarctions and five (11%) deaths, for a cumulative rate of 28% for any adverse outcome occurring in 13 of 46 patients. CONCLUSIONS: TEC atherectomy followed by immediate Palmaz-Schatz coronary stenting of stenoses in old (> 9 years) saphenous vein grafts can be successfully performed, with a low incidence of procedural and hospital complications. Clinical restenosis rates are low and less than those previously reported; however, late morbid cardiac events are still frequent in this high risk group of patients. These observational findings suggest that this technique may improve percutaneous management of vein graft disease, but optimal long-term management strategies remain to be determined.

Aged↗
PubMedDate not supplied

Biliary ductal shave biopsy with use of the Simpson atherectomy catheter.

PURPOSE: The authors performed percutaneous biliary ductal shave biopsy through an existing transhepatic biliary drainage tract with use of the Simpson atherectomy catheter. The technical feasibility, sensitivity, and complications of this endoluminal biopsy method were studied when used for diagnosis of biliary ductal and pancreatic neoplasm. PATIENTS AND METHODS: Nineteen bile duct shave biopsies were performed in 18 patients with symptomatic biliary obstruction by using a 9-F Simpson directional atherectomy catheter. Seven of the 18 patients underwent nine negative percutaneous needle biopsies prior to undergoing percutaneous biliary drainage. Results of previous transcatheter brush biopsies performed through the transhepatic tract were negative in all patients. RESULTS: A histologic diagnosis was obtained in 15 of the 19 procedures (sensitivity, 0.79) and included cholangiocarcinoma (n = 7), pancreatic carcinoma (n = 5), metastatic carcinoma (n = 2), and primary sclerosing cholangitis (n = 1). Two complications occurred in the 19 procedures (10.5%), both transient but significant hemorrhage, one of which necessitated transfusion. CONCLUSIONS: Percutaneous biliary ductal shave biopsy with the Simpson atherectomy catheter can be performed successfully through the transhepatic approach and is a sensitive endoluminal biopsy technique, particularly in patients with tumors of the biliary tree that are not diagnosed by means of percutaneous needle biopsy or endoscopic methods. Disadvantages of this method include the high cost of the device and risk of hemorrhage. Atherectomy shave biopsy should be used cautiously and only after more conventional biopsy methods have been employed.

Atherectomy↗
PubMedDate not supplied

Phase I results of pullback atherectomy for hemodialysis access.

PURPOSE: Balloon angioplasty and directional atherectomy frequently have short-lived results for stenoses associated with hemodialysis. Results are reported for a phase I trial of the pullback atherectomy catheter (PAC) for treatment of hemodialysis access-related stenoses. PATIENTS AND METHODS: Six intragraft and six venous stenoses in nine patients were treated with the PAC. Two lesions were treated with adjunctive balloon angioplasty, and two were treated with adjunctive directional atherectomy. Clinical and angiographic follow-up were obtained for all patients. All specimens were examined histologically. RESULTS: Initial procedural success was achieved in 83% of stenoses (10 of 12). For intragraft stenoses, the 6-month primary patency was 60% (three of five) and the 6-month secondary patency was 80% (four of five). All six venous stenoses restenosed or thrombosed within 3 months. All specimens contained fibrous plaque or intimal hyperplasia. In addition, all six venous stenosis specimens contained media and two contained adventitia. Significant complications during treatment of venous stenoses included severe venous spasm in three and venous pseudoaneurysms in two. One PAC tip fracture occurred during treatment of an intragraft stenosis. CONCLUSION: Pullback atherectomy is potentially safe and effective for intragraft stenoses; however, it is not safe or effective for venous stenoses.

Adult↗
PubMed1993

[Long-term results of percutaneous atherectomy in peripheral arterial occlusive disease].

In a retrospective study the indications and the long-term results of percutaneous atherectomy of a nonselected group of patients were analysed. From March 1988 to November 1989, 94 patients suffering from peripheral vascular disease were treated using Simpson's atherectomy technique. There were 132 lesions, 101 stenoses and 31 occlusions in a total of 94 patients. The primary success rate was 95%. After 12 months of follow-up the cumulative patency rate was 69% and after 24 months, 42%. After a follow-up period of 15 months patent arteries and recurrences were recorded and the results used to analyse the factors that influence patency after Simpson atherectomy. The patency rate is 71% in diabetics and 62% in non-diabetics. It is 51% in occlusions and 73% in stenoses. The patency rate in patients with fair runoff is 69%, in patients with poor runoff 60%. Comparing these results with historical studies concerning balloon dilation the results are poor. Residual stenoses after balloon dilation seem to be the optimal indication for percutaneous atherectomy.

Adult↗
PubMed2001

Reduction in periprocedural enzyme elevation by abciximab after rotational atherectomy of type B2 lesions: Results of the Rota ReoPro randomized trial.

BACKGROUND: Abciximab has been shown to reduce ischemic complications and creatine kinase-myocardial band (CK-MB) elevation of both simple and complex coronary interventions. In addition to the procedural complications, one of the important mechanisms for CK-MB elevation after rotational atherectomy is an interaction between platelets and the atheromatous debris. METHODS: This study was conducted to determine whether abciximab would limit the extent of periprocedural CK-MB release after rotational atherectomy of American Heart Association/American College of Cardiology type B(2) lesions in a double-blind, randomized, placebo-controlled manner. A total of 100 lesions in 100 patients were randomized with the primary end point being a CK-MB elevation of >16 U/L. RESULTS: Procedural success was achieved in 100% in the abciximab arm compared with 98% in the placebo group with any CK-MB elevation >16 U/L of 8% in the abciximab versus 22% in the placebo group (P =.04). The peak creatine phosphokinase level (units per liter) was 102 +/- 14 versus 153 +/- 22 (P =.05) and the peak CK-MB level was 12.8 +/- 1.8 versus 24.6 +/- 3.5 (P =.06) between the abciximab and placebo groups, respectively. Slow-flow or postprocedure chest pain occurred in 14% in the abciximab group versus 30% in the placebo group (P =.04). There was 1 Q-wave myocardial infarction in the placebo arm and 1 nonhemorrhagic stroke in the abciximab group. CONCLUSIONS: Therefore the Rota ReoPro randomized trial revealed the benefit of abciximab during rotational atherectomy in reducing procedural morbidity and CK-MB elevation, and its routine use can be justified even in moderately complex lesions undergoing rotational atherectomy.

Abciximab↗
PubMed1993

Clinical and histological determinants of smooth-muscle cell outgrowth in cultured atherectomy specimens: importance of thrombus organization.

BACKGROUND: Coronary atherectomy provides a unique opportunity to obtain plaque tissue from a wide variety of clinical syndromes. We investigated the relation between the clinical status and histopathological substrate of tissue retrieved during directional coronary atherectomy and the proliferative and migratory potential of smooth-muscle cells judged from successful outgrowth during cell culture. METHODS: After directional coronary atherectomy, tissue samples were examined macroscopically, divided into two equal pieces, and separately subjected to cell culture and histopathological study. Cell culture was performed using an explant technique. In-vitro smooth-muscle cell outgrowth was related to clinical and histological variables. RESULTS: Atherosclerotic tissue was obtained from 98 consecutive atherectomy procedures. Histological examination revealed a broad spectrum of appearances, ranging from complex atheroma containing dense fibrous tissue, calcium deposits, macrophages, and necrotic debris to neointimal proliferation and organized thrombi. Smooth-muscle cell outgrowth was observed in 43 of the 98 samples (44%). Although not affected by any of the clinical variables, cell outgrowth was influenced by histological variables, in particular the presence of organizing thrombi. Outgrowth was successful in eight out of 10 samples with thrombus (80%) and in only 35 out of 88 (40%) without (P = 0.03). CONCLUSION: The presence of organizing thrombi in the retrieved tissue facilitates smooth-muscle cell outgrowth and suggests an enhanced proliferative and migratory potential. These findings may be relevant to the understanding of neointimal proliferation in coronary syndromes where mural thrombosis is likely to occur.

Angina Pectoris↗
PubMed1995

Directional coronary atherectomy for lesions of the proximal left anterior descending artery: initial clinical results, complications and histopathological findings.

BACKGROUND: Directional coronary atherectomy is a percutaneous technique which extends the role of balloon angioplasty to bulky eccentric coronary lesions. AIMS: To report the early experience, clinical results, complications and histopathological findings of directional coronary atherectomy (DCA) in proximal left anterior descending artery (LAD) stenosis. METHODS: Study of 25 lesions in 24 patients on whom directional atherectomy was performed on the proximal LAD artery with the Simpson coronary atherectomy device. RESULTS: Twenty-five procedures were performed on 24 patients with stenosis in the proximal LAD artery. There were 21 males and three females with a mean age of 56.5 years. Sixteen patients presented with stable angina and eight with unstable angina. Eight patients had previous myocardial infarction (MI). Angiographic success was obtained in 24 of 25 lesions (96%). The mean lesion length was 13.1 +/- 3.7 mm and the mean LAD artery diameter was 3.6 +/- 0.5 mm. Minimal luminal diameter improved from 0.9 +/- 0.4 mm to 3.0 +/- 0.5 mm and the percentage diameter stenosis reduced from 75 +/- 12% to 16 +/- 9%. Complications included acute occlusion in one patient, non-Q MI in three patients, local vascular complications in one patient and side-branch loss in one patient. Histology demonstrated fibrous cap of atherosclerotic plaque in 100%, media and internal elastic lamina in 28% and intimal hyperplasia in 100% of restenotic lesions and 27% of native lesions. Restenosis rates in angiographically restudied patients was 27%. The mean minimal luminal diameter at follow-up was 2.3 +/- 0.9 mm and the mean percentage diameter stenosis was 35 +/- 21%. CONCLUSION: From this initial study, we conclude that DCA is an effective and safe procedure for the treatment of large proximal LAD lesions. DCA provides a large luminal diameter and "smoother' angiographic appearance compared to coronary angioplasty. Acute complication rates are low and restenosis rates were comparable with percutaneous transluminal coronary balloon angioplasty.

Adult↗
PubMed1993

Mechanical dilatation rather than plaque removal as major mechanism of transluminal coronary extraction atherectomy.

Atherectomy with the transluminal extraction endarterectomy catheter (TEC) is a new approach for treatment of coronary artery disease, which continues to undergo FDA investigational studies. The major mechanism of the TEC device should be excision of plaque and its removal due to suction applied through an attached vacuum. We report about the acute results in 24 patients treated with TEC atherectomy in native vessels and the outcome of 18 patients who, until recently, underwent follow-up catheterization after 6 months. The procedure was successful (residual stenosis less than 50%) in 7 of 24 patients with TEC atherectomy alone (29%); 15 of 24 patients (65%) required additional PTCA in order to achieve angiographic success (10 of 24) or to treat total occlusion (2 of 24) or distal embolization (3 of 24) following atherectomy. One TEC attempt failed due to guiding catheter problems, another major complication was a vessel perforation leading to a non-Q wave infarction. The minimal residual diameter after passage of the stenosis (prior to additional PTCA) with the 5.5 Fr catheter (n = 14) was 1.5 +/- 0.2 mm, with the 6 Fr catheter (n = 9) 1.8 +/- 0.4 mm, and 2.2 +/- 0.2 mm using the 7 Fr catheter (n = 10). The histologic findings revealed intimal cells, fibrous tissue, and homogenate with no identifiable tissue in five cases (21%), whereas in 17 patients (72%) light microscopy could only assess blood cells.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed2005

Rotational coronary atherectomy in acute ST-segment elevation myocardial infarction.

The usual large thrombus load encountered in acute ST-elevation myocardial infarctions increases the likelihood for slow-flow or no-reflow during percutaneous coronary intervention. The use of rotational atherectomy in this clinical scenario is usually prohibitive due to the potential for further induction of platelet activation and aggregation by the rotating burr. In this case presentation, primary percutaneous coronary intervention for an acute ST-elevation myocardial infarction was performed. Due to the complex vessel geometry, pretreatment with atherectomy was mandatory with the only available atherectomy device in the laboratory: Rotablator. This case represents the first report on the successful use of rotational coronary atherectomy in the setting of acute ST-elevation myocardial infarction.

Aged↗