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Quantitative angiography after directional coronary atherectomy
P W Serruys1, V A Umans, B H Strauss
1Catheterisation Laboratory, Thoraxcenter, Erasmus University, Rotterdam, The Netherlands.
Insights
Directional coronary atherectomy improved immediate angiographic results compared to balloon angioplasty. Further randomized studies are needed to confirm its safety and efficacy.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
Background:
- Directional coronary atherectomy (DCA) is an alternative revascularization technique.
- Quantitative analysis is crucial for assessing procedural outcomes.
Purpose of the Study:
- To quantitatively assess the immediate angiographic results of DCA.
- To compare DCA with conventional balloon angioplasty (BA) in matched lesions.
Main Methods:
- A case series of 62 patients undergoing DCA at a tertiary referral center.
- Comparison group included 37 patients with matched lesions undergoing BA.
- Primary outcome measure was the increase in minimal luminal diameter.
Main Results:
- DCA achieved an 87% angiographic success rate, increasing minimal luminal diameter from 1.1 mm to 2.5 mm.
- DCA significantly increased minimal luminal diameter more than BA (1.6 mm vs. 0.8 mm, p < 0.0001).
- In-hospital complications occurred in 6 patients, including infarctions and one death; 80% were symptom-free at six months.
Conclusions:
- DCA provides superior immediate angiographic results compared to BA.
- The complication rate in this preliminary series suggests a potential learning curve.
- Randomized trials are necessary to establish the safety profile of DCA relative to BA.
Objective:
To assess by quantitative analysis the immediate angiographic results of directional coronary atherectomy. To compare the effects of successful atherectomy with those of successful balloon dilatation in a series of patients with matched lesions.
Design:
Case series.
Setting:
Tertiary referral centre.
Patients:
62 patients in whom directional coronary atherectomy was attempted between 7 September 1989 and 31 December 1990.
Interventions:
Directional coronary atherectomy.
Main Outcome Measures:
Increase in minimal luminal diameter of coronary artery segment.
Results:
Angiographic success on the basis of intention to treat was obtained in 54 patients (87%). In four patients the lesion could not be crossed by the atherectomy device; all four had an uneventful conventional balloon angioplasty. Four of the 58 patients who underwent atherectomy were subsequently referred for coronary bypass surgery because of failure or complications; three of them sustained a transmural infarction. In the successful cases, coronary atherectomy resulted in an increase in the minimal luminal diameter from 1.1 mm to 2.5 mm with a concomitant decrease of the diameter stenosis from 62% to 22%. In the subset of 37 patients in which the changes induced were compared with conventional balloon angioplasty atherectomy increased the minimal luminal diameter more than balloon angioplasty (1.6 v 0.8 mm; p less than 0.0001). Conventional histology showed media or adventitia in 26% of the atherectomy specimens. In hospital complications occurred in six patients who had undergone a successful procedure: two transmural infarctions, two subendocardial infarctions, one transient ischaemia attack, and one death due to delayed rupture of the atherectomised vessel. All patients were clinically evaluated at one and six months. One patient had persisting angina (New York Heart Association class II), one patient sustained a myocardial infarction, one patient underwent a percutaneous transluminal coronary angioplasty for early restenosis, and one patient underwent coronary bypass surgery because of a coronary aneurysm formation. At six months 80% (36/47) of the patients were symptom free.
Conclusions:
Coronary atherectomy achieved a better immediate angiographic result than balloon angioplasty; however, in view of the complication rate in this preliminary series, which may be related to a learning curve, a randomised study is needed to show whether this procedure is as safe as a conventional balloon angioplasty.