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Restenosis after directional coronary atherectomy
T Hinohara1, G C Robertson, M R Selmon
1Pacific Foundation for Cardiovascular Research, Redwood City, California 94062.
Insights
Restenosis after directional coronary atherectomy affects 42% of patients, particularly in saphenous vein grafts. Factors like lesion length and device size influence restenosis risk.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Medical Device Technology
Background:
- Directional coronary atherectomy (DCA) is a recognized treatment for obstructive coronary artery disease.
- Limited data exists on restenosis rates and associated risk factors following DCA procedures.
Purpose of the Study:
- To determine the incidence of restenosis after successful DCA.
- To identify patient and lesion-specific risk factors contributing to restenosis.
Main Methods:
- Prospective follow-up of 289 patients (332 lesions) treated with DCA (1986-1989).
- Clinical follow-up (98%) and angiographic follow-up (82%) at ~6 months.
- Quantitative angiographic analysis defining restenosis as >50% stenosis.
Main Results:
- 42% of patients experienced angiographic restenosis.
- Higher restenosis rates observed in saphenous vein grafts (53-82%) versus native arteries (31%).
- Risk factors for restenosis included saphenous vein graft use, hypertension, longer lesions, smaller vessel diameter, noncalcified lesions, and smaller device size (6F).
Conclusions:
- Restenosis remains a significant limitation of DCA.
- Favorable outcomes may be associated with larger vessels, shorter lesions, and larger devices (7F).
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.