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At least 19 recordsLinked to original sources
PubMed1999

Mid-term follow-up of coronary artery aneurysm after directional coronary atherectomy.

Coronary artery aneurysm (CAA) occurs in 6-12% of lesions after directional coronary atherectomy (DCA). The prognosis and the optimal treatment for DCA-related CAAs have not been well known. Therefore, we reviewed the clinical course of 214 consecutive patients with DCA-related CAAs who underwent DCA in our hospital. Follow-up coronary angiography 6 months after DCA was completed in 193 patients (212 lesions) and 14 lesions with CAAs (14 patients) were detected. We evaluated these 14 lesions by repeat coronary angiography at an average of 32 months after DCA in comparison with the adjacent reference vessel. Twelve of the 14 patients have been uneventful but 2 suffered from de novo angina due to new stenotic lesion unrelated to the DCA procedures. We compared the preprocedural angiographic characteristics and periprocedural parameters between the 14 lesions with CAAs[CAA(+)group] and the 198 without CAAs [CAA(-)group], but found no significant differences. Histological examination of specimens retrieved during atherectomy demonstrated that subintimal resection was more frequent in the CAA(+)group(57%) than the CAA(-)group(31%). The diameter of the aneurysm divided by the reference diameter was significantly larger at 6 months immediately after DCA(1.71 +/- 0.21 vs 1.31 +/- 0.18, p < 0.05) but did not change subsequently (1.68 +/- 0.23). Our retrospective analysis revealed a good mid-term (an average of 32 months) prognosis for CAAs found by routine follow-up coronary angiography and also demonstrated that the depth of resection was significantly associated with aneurysm formation.

Adult↗
PubMed1990

Comparison of dissection rates and angiographic results following directional coronary atherectomy and coronary angioplasty.

Directional coronary atherectomy is a new percutaneous transluminal technique for treating occlusive coronary artery disease. In this study, angiographic results (i.e., residual stenosis and angiographic evidence of postprocedure dissection) after directional coronary atherectomy and balloon angioplasty were compared. The atherectomy group consisted of 91 lesions in 83 consecutive patients who underwent either left anterior descending artery or right coronary artery atherectomy. The angioplasty group consisted of 91 lesions in 84 patients that were matched with the atherectomy lesions with respect to vessel and whether the lesion was a restenosis lesion. The mean preprocedure diameter stenosis was 76% in both groups as measured quantitatively with electronic calipers. After the procedure, the mean residual diameter stenosis of the atherectomy lesions was 13 +/- 17%, whereas for the angioplasty lesions it was 31 +/- 18% (p less than 0.001). Success rates in both groups were similar (94.5 and 93.4%, respectively). The incidence of postprocedure dissection was 11% in the atherectomy group and 37% in the angioplasty group (p less than 0.0001). Directional coronary atherectomy results in significantly improved postprocedure angiographic appearances due to significantly less severe residual stenosis and lower incidence of dissection.

Angioplasty, Balloon, Coronary↗
PubMed1996

Directional coronary atherectomy for coronary artery spasm refractory to medical therapy.

A patient with severe medically refractory coronary artery spasm was treated successfully with coronary atherectomy of a mild (40%) left anterior descending artery stenosis. Before the procedure, the patient was dependent on intravenous nitroglycerin because of daily episodes of angina with ST-segment elevation despite receiving multiple combinations of antianginal therapies. Clinical response to coronary atherectomy was prompt and dramatic.

Adult↗
PubMed1996

Enhanced manipulation of directional coronary atherectomy and coronary angioplasty guide catheters.

Manipulation of thin-walled coronary guiding catheters, especially directional coronary atherectomy guides, may sometimes be difficult. This is particularly so in patients with tortuous or ectatic aorto-iliac arterial systems. To improve torque transmission and eliminate kinking, the introducer catheter or a smaller caliber diagnostic catheter is advanced to within 1.5 cm of the distal guide tip. Connecting the rotating hemostatic valve to the introducer hub or diagnostic catheter proximally allows distal contrast injections and pressure monitoring via this inner catheter. Other methods of enhancing guide catheter manipulation are also discussed.

Atherectomy, Coronary↗
PubMed1998

Directional coronary atherectomy versus coronary angioplasty in vessels larger than 3 mm in diameter.

It has been proposed that directional coronary atherectomy (DCA) should be an intervention of choice in larger vessels as one can achieve a greater minimal luminal diameter with DCA than with percutaneous transluminal coronary angioplasty (PTCA). This in turn should translate into a higher success rate and may even reduce the restenosis rate. The aim of this study was to compare DCA versus PTCA in vessels > 3 mm in diameter. One hundred fifty consecutive patients who met the inclusion criteria and had DCA were compared to 150 similarly selected PTCA patients. PTCA patients were selected from the era immediately preceding the advent of DCA so that selections bias could be excluded. All patients with ostial lesions, restenosis, vessels < 3 mm in diameter, and vessels with more than two significant lesions were excluded. Distal segments and circumflex cases were excluded as they formed a small subsegment. Both groups were similar in terms of demographic, clinical and angiographic variables. Quantitative analysis showed that the initial net gain was significantly greater in the DCA group than in the PTCA group (2.36 +/- 0.8 mm vs. 1.78 +/- 0.7 mm; p < 0.05). Residual stenosis was 11% with DCA compared to 33% with PTCA (p < 0.05). Despite these improved anatomical results the procedural success rates were similar (91.5% vs 84%). Major in hospital complications (death, acute occlusion, MI, emergency CABG, re-do) were higher in the DCA group than in the PTCA group (12% vs 6%). Clinical follow-up on 276 patients (150 DCA vs 126 PTCA) showed a 6 month clinical restenosis rate of 18% vs 28%, respectively. The incidence of re-do in 24 hours for acute occlusion was 6% for DCA and 1% for PTCA. In large-sized vessels DCA results in a lower restenosis rate. However, despite a lower incidence of residual stenosis, the complication rate tends to be higher with DCA (p < 0.05).

Aged↗
PubMed1990

Combined percutaneous coronary atherectomy and coronary angioplasty: experience in 19 consecutive patients.

Among 82 patients undergoing coronary atherectomy, 19 (23%) underwent this procedure in combination with coronary angioplasty. The most frequently involved vessel was the left anterior descending coronary artery. In 11 patients (58%), attempted atherectomy preceded coronary angioplasty. In 6 of the 11, angioplasty was used after the atherectomy catheter could not be positioned across the lesion; 4 patients underwent "rescue" angioplasty after developing vessel occlusion related to atherectomy and 1 patient had an unsatisfactory result of atherectomy. The success rate of the combined intervention was 82% for these 11 patients. In eight patients (42%), atherectomy was performed after initial angioplasty. In four of the eight, atherectomy was a rescue procedure to manage vessel occlusion by thrombus or intimal dissection and was successful in three. In the other four, angioplasty was performed to establish an easier passage for the atherectomy catheter and was successful in three. Thus, the success rate of the combined intervention was 75% for these eight patients. The overall success rate for all 19 patients was 79%; there was one in-hospital death and one non-Q wave infarction, and one patient required immediate coronary artery surgery. Two other patients underwent coronary artery surgery before hospital discharge. Combined intervention with coronary angioplasty and atherectomy seems to be a relatively safe and effective approach in selected patients when either of these procedures alone is unsuccessful or is accompanied by acute coronary complications.

Adult↗
PubMed2004

Stenting after directional coronary atherectomy compared with directional coronary atherectomy alone and stenting alone: a serial intravascular ultrasound study.

BACKGROUND: Directional coronary atherectomy prior to stent implantation (DCA-stent) is expected to be an effective approach to reduce restenosis. The purpose of this study was to determine whether DCA-stent has advantages over DCA alone or stenting alone using serial intravascular ultrasound (IVUS). METHODS AND RESULTS: Serial (pre-, post- and follow-up) IVUS was performed in 187 native coronary lesions treated with each of the 3 strategies. External elastic membrane cross-sectional area (CSA), lumen CSA and plaque CSA were measured. Baseline characteristics were similar. Postprocedural lumen CSA was largest after DCA-stent (11.2+/-2.7 mm2) and DCA (10.8+/-2.5 mm2) than stenting alone (9.0+/-2.9 mm2) (p<0.0005). Follow-up lumen loss was similar. As a result, follow-up lumen CSA was largest after DCA-stent (DCA-stent: 9.1+/-3.4 mm2, DCA: 7.8+/-4.2 mm2, stent: 6.3+/-2.6 mm2, p<0.0005). There was a trend toward a lower rate of restenosis with DCA-stent (DCA-stent, 12.5%; DCA, 18.3%; stent, 18.8%; p=0.57). CONCLUSIONS: DCA-stent is superior to both DCA alone and stent alone in terms of the ability to gain a larger lumen as assessed by IVUS.

Aged↗
PubMed1996

[Directional coronary atherectomy in coronary dissection?].

Significant local dissection at the site of angioplasty remains the most common cause of complications at balloon dilatation. In the past, the only solution was to transfer the patient for emergency coronary artery bypass grafting. Recent improvements in equipment and increasing experience mean that alternative instrumental methods are now available to manage dissection; in particular, by directional atherectomy and stent implantation, thus possibly avoiding surgery. In this article, the use of atherectomy as management for acute local dissection will be discussed, with special reference to the potential difficulties which may be encountered. Data showing that excellent immediate results and good long-term success can be achieved with atherectomy for acute dissection using careful selection criteria will be presented, indicating that atherectomy is a valid alternative instrumental treatment for the management of such dissection.

Aortic Dissection↗
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↗
PubMed1991

Brachial approach directional coronary atherectomy of right coronary artery saphenous vein bypass grafts.

We describe here a technique for performing directional coronary atherectomy to right coronary artery saphenous vein bypass grafts from the brachial approach using a long introducer sheath system. This technique has the advantages of 1) avoiding femoral artery trauma and 2) ease of access into the bypass graft, avoiding occasional problems with guide catheter kinking or non-coaxial alignment.

Aged↗
PubMed2000

A synergistic approach to optimal stenting: directional coronary atherectomy prior to coronary artery stent implantation--the AtheroLink Registry. AtheroLink Study Group.

OBJECTIVES: The AtheroLink registry sought to observe the effect of plaque burden reduction by directional coronary atherectomy (DCA) prior to stenting on acute lesion success rate, on the clinical success rate and on the incidence of in-stent restenosis six months after intervention. BACKGROUND: Although coronary stenting has reduced restenosis, its effect has been less favorable in complex lesions with a high plaque burden that results from suboptimal stent expansion. Therefore, plaque removal by DCA may improve the results of coronary stenting. METHODS: A total of 167 patients with >60% stenosis in a native coronary artery of 2.8 to 4.0 mm in diameter were enrolled in 10 study centers on an intention-to-treat basis. All patients underwent DCA aimed at an optimal result (residual diameter stenosis <20%) followed by stenting. Angiographic follow-up was performed in 120 (71.8%) patients at 5.3+/-2.8 months. RESULTS: Lesion success was achieved in 164/167 (98.2%) patients, and the clinical success rate was 95.2% (159/167 patients). The overall restenosis rate in the 120 patients with angiographic follow-up was 10.8% (13/120). Incidence of restenosis was lower (8.4%) in patients with optimal stent deployment following DCA compared to patients with a persisting caliber reduction >15% (restenosis rate 15.3.%) and restenosis occurred with a significantly higher frequency (p<0.04) in distal lesions (37.5%) compared to proximal stenoses (9.0%). CONCLUSIONS: This observational multicenter registry points to a potential reduction in restenosis by a synergistic approach of DCA and stenting performed under routinely accessible angiographic guidance. Therefore, multicenter-based randomized clinical trials are clearly warranted to finally clarify the validity of this complex approach versus conventional angioplasty plus stenting.

Aged↗
PubMed1996

Aortic dissection during directional coronary atherectomy.

Directional coronary atherectomy has been applied to aorto-ostial lesions with higher success and lower complication rates than conventional balloon angioplasty. Aortic injuries have been reported with this technique, most resulting from the tip of the catheter. In this report, an aortic dissection caused by the shaft of the directional coronary atherectomy catheter is described.

Aortic Dissection↗
PubMed1999

Effects of adjunctive balloon angioplasty after intravascular ultrasound-guided optimal directional coronary atherectomy: the result of Adjunctive Balloon Angioplasty After Coronary Atherectomy Study (ABACAS).

OBJECTIVES: This study was conducted to evaluate: 1) the effect of adjunctive percutaneous transluminal coronary angioplasty (PTCA) after directional coronary atherectomy (DCA) compared with stand-alone DCA, and 2) the outcome of intravascular ultrasound (IVUS)-guided aggressive DCA. BACKGROUND: It has been shown that optimal angiographic results after coronary interventions are associated with a lower incidence ofrestenosis. Adjunctive PTCA after DCA improves the acute angiographic outcome; however, long-term benefits of adjunctive PTCA have not been established. METHODS: Out of 225 patients who underwent IVUS-guided DCA, angiographically optimal debulking was achieved in 214 patients, then theywere randomized to either no further treatment or to added PTCA. RESULTS: Postprocedural quantitative angiographic analysis demonstrated an improved minimum luminal diameter (2.88 +/- 0.48 vs. 2.6 +/- 0.51 mm; p = 0.006) and a less residual stenosis (10.8% vs.15%; p = 0.009) in the adjunctive PTCA group. Quantitative ultrasound analysis showed a larger minimum luminal diameter (3.26 +/- 0.48 vs. 3.04 +/- 0.5 mm; p < 0.001) and lower residual plaque mass in the adjunctive PTCA group (42.6% vs. 45.6%; p < 0.001). Despite the improved acute findings in the adjunctive PTCA group, six-month angiographic and clinical results were not different. The restenosis rate (adjunctive PTCA 23.6%, DCA alone 19.6%; p = ns) and target lesion revascularization rate (20.6% vs. 15.2%; p = ns) did not differ between the groups. CONCLUSIONS: With IVUS guidance, aggressive DCA can safely achieve optimal angiographic results with low residual plaque mass, and this was associated with a low restenosis rate. Although adjunctive PTCA after optimal DCA improved the acute quantitative coronary angiography and quantitative coronary ultrasonography outcomes, its benefit was not maintained at six months.

Aged↗
PubMed1996

[A case of coronary perforation after directional coronary atherectomy].

Directional coronary atherectomy was performed on a 69-year-old female with angina pectoris. She suffered from coronary perforation as a result of cardiac tamponade and shock. Pericardial drainage and hemostasis were performed immediately using a perfusion catheter. The patient was transferred to the operating room for perforation repair and coronary artery bypass grafting to the distal portion of the left anterior descending artery. The procedure was performed successfully. Although acute coronary perforation associated with directional coronary atherectomy is rare, it can be managed temporarily by a perfusion catheter and we successfully performed coronary artery bypass grafting.

Aged↗
PubMed1997

Intravascular ultrasound in the setting of directional coronary atherectomy and percutaneous transluminal coronary rotational atherectomy.

The first section of this article reviews how intracoronary ultrasound (ICUS) has been used to identify the mechanisms of action of directional coronary atherectomy (DCA) and examines the influence of plaque composition and morphology on DCA outcomes. The process of restenosis is then described. Results from trial using ICUS-guided DCA are evaluated, demonstrating how the information obtained from ICUS is being used to improve the angiographic and clinical outcomes of directional atherectomy. Finally, data are incorporated to provide practical applications for the use of DCA.

Angioplasty, Balloon, Coronary↗
PubMed1990

Recent developments in coronary atherectomy.

Percutaneous coronary atherectomy (PCA) is one of the newest treatments for coronary artery disease. In this technique, arterial plaque is mechanically removed from the interior of the artery by a tool located on the tip of a catheter placed inside the coronary artery nonsurgically. Clinical studies of several coronary atherectomy devices are in process in the United States and abroad. As atherosclerotic material is removed or debulked, abrupt reclosure or restenosis rates may potentially be lower compared with conventional percutaneous transluminal coronary angioplasty (PTCA). PCA may also clear longer and more diffuse lesions, with long-term clinical success, than are successfully being treated by PTCA. Due to the rigidity of the atherectomy catheter, only lesions in major coronary arteries may be approached with these devices at present. It is hoped that PCA may supplement current methods of treating coronary artery disease, including coronary artery bypass graft surgery and PTCA.

Angioplasty, Balloon, Coronary↗
PubMed1992

Coronary artery aneurysm formation following directional coronary atherectomy.

Directional coronary atherectomy has recently become available to treat coronary stenosis by excision and removal of tissue. The optimal depth of resection by this method has not been determined and complications have occurred. This report describes the formation of a coronary aneurysm at an atherectomy site in an asymptomatic patient, a finding not reported previously.

Angioplasty, Balloon, Coronary↗
PubMed2000

Pathophysiological insights from studies of retrieved coronary atherectomy tissue.

Coronary atherectomy offers the intuitive advantage of removing tissue mass in order to improve blood flow. A second major benefit of atherectomy is the opportunity to study lesion tissue and make pathophysiological insights. The value of the latter cannot be over emphasized, as current animal models for the study of atherosclerosis and restenosis are fraught with limitations. In this review, we outline some of the key descriptive findings that have emerged from the study of atherectomy specimens. Specifically, we will focus on the role of smooth muscle cell proliferation, thrombus organization and matrix formation in primary atherosclerotic lesions, as well as restenotic lesions after balloon angioplasty and stenting.

Apoptosis↗