Related Experiment Videos
[Guided coronary atherectomy: preliminary results]
A Iñíguez Romo1, C Macaya Miquel, J Casado Larre
1Servicio de Exploración Cardiopulmonar, Hospital Universitario San Carlos, Madrid.
Insights
Directional coronary atherectomy (DCA) effectively removes plaque from diseased arteries, offering a promising alternative to angioplasty. This study shows high success rates in treating various coronary artery lesions with minimal complications.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Medical Devices
Context:
- Coronary artery disease necessitates advanced treatment modalities.
- Percutaneous transluminal coronary angioplasty (PTCA) has limitations including restenosis.
- Directional coronary atherectomy (DCA) offers a selective approach to plaque removal.
Purpose:
- To evaluate the efficacy and safety of Simpson's atherotome for directional coronary atherectomy (DCA).
- To assess initial procedural success and complication rates in patients undergoing DCA.
- To compare pre- and post-procedure stenosis in treated coronary lesions.
Summary:
- Fifteen coronary lesions in 14 patients were treated using DCA with Simpson's atherotome.
- Indications included unstable angina, stable angina, and silent myocardial ischemia.
- Initial angiographic success (residual stenosis <50%) was achieved in 100% of lesions, reducing stenosis from 84% to 16%.
Impact:
- DCA demonstrated high initial success rates for treating complex coronary lesions.
- The procedure avoided the need for urgent coronary artery bypass surgery.
- While generally safe, one patient experienced a fatal complication (cardiogenic shock).
Abstract:
Coronary atherectomy implies removing atheromatous material from the diseased coronary arterial wall. This technique has emerged as an attractive alternative to conventional percutaneous transluminal coronary angioplasty procedures, in an attempt to diminish both initial procedural failure and restenosis rate. Among different technologies, the Simpson's atherotome provides a means of performing directional (i.e. selective) coronary atherectomy (DCA). This device implements a coaxial catheter which is advanced into the lesion over a steerable guidewire. Its distal tip includes a hollow metallic cylinder with a lateral window. Removal of the material is accomplished by a rotating cutter which can be moved distally, once the device's window has been orientated facing the lesion. We have performed 14 DCA in 14 patients. Mean age was 58 years and 12 patients were male. The technique was indicated for unstable angina (7 patients), stable angina (4 patients) and silent myocardial ischemia (3 patients). Fifteen lesions were attempted (13 original and two with restenosis), located as follows: nine in the left anterior descending coronary artery, three in the right coronary artery and three in the left circumflex artery. Eleven lesions were proximal and four were located in mid coronary segments. Twelve lesions (80%) were eccentric, and five (33%) were irregular. Initial angiographic success (residual stenosis less than 50%) was obtained in all 15 lesions (100%). Pre-DCA stenosis was 84 +/- 5% and post-DCA stenosis was 16 +/- 6%. There was no need for urgent coronary artery by-pass surgery and no patient developed an acute myocardial infarction in relation to the procedure. A 82-year-old woman died after the procedure in cardiogenic shock.(ABSTRACT TRUNCATED AT 250 WORDS)