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Directional coronary atherectomy: the Vienna experience.
K Kiss1, M M Hirschl, P Wexberg
1Department for Cardiology, University Clinic of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria. katharina.kiss@univie.ac.at
Journal of Interventional Cardiology
|June 11, 2002
Summary
Directional coronary atherectomy (DCA) is effective in routine clinical practice for unselected patients, showing results comparable to selected cohorts. Preprocedural minimal lumen diameter is crucial for predicting outcomes and optimizing results.
Area of Science:
- Cardiovascular Interventions
- Interventional Cardiology
- Vascular Surgery
Background:
- Multicenter trials indicate success of directional coronary atherectomy (DCA) in specific patient groups.
- This study assesses DCA's applicability in a nonselected patient cohort within a routine clinical setting.
Purpose of the Study:
- To evaluate the effectiveness and safety of directional coronary atherectomy (DCA) in a consecutive, unselected patient series.
- To compare DCA outcomes in daily practice with results from highly selected patient cohorts.
Main Methods:
- Directional coronary atherectomy (DCA) was performed as a standard procedure on 45 suitable patients.
- Quantitative coronary angiography was conducted pre- and postprocedure, with a 6-month follow-up.
- Post-procedural interventions (ballooning or stenting) were reserved for unsatisfactory results.
Main Results:
- Optimal atherectomy (<20% residual stenosis) was achieved in 52% of lesions; 100% had <50% residual stenosis.
- Procedure-related complications occurred in 6% of patients (1 major, 2 minor).
- The 6-month restenosis rate was 29%, with preprocedural minimal lumen diameter significantly predicting outcomes (P < 0.0001).
Conclusions:
- Directional coronary atherectomy (DCA) is a viable technique for routine clinical use, with complication and restenosis rates similar to selective cohorts.
- Preprocedural minimal lumen diameter assessment is vital for patient selection and achieving optimal DCA results.
- DCA offers comparable outcomes to conventional methods and can be used as an alternative or in conjunction with them.