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High speed rotational coronary atherectomy for patients with diffuse coronary artery disease
P S Teirstein1, D C Warth, N Haq
1Cardiology Division of Scripps Clinic and Research Foundation, La Jolla, California 92037.
Insights
High-speed rotational coronary atherectomy using the Rotablator showed success in 76% of patients. Procedural success and restenosis rates were significantly influenced by coronary lesion length, with longer lesions faring worse.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Surgery
Background:
- Coronary artery disease (CAD) poses a significant health burden.
- Rotational coronary atherectomy (Rotablator) is an option for complex lesions.
- Suboptimal candidates for balloon angioplasty require alternative revascularization strategies.
Purpose of the Study:
- To evaluate the efficacy and safety of high-speed rotational coronary atherectomy (Rotablator) in patients unsuitable for balloon angioplasty.
- To assess the impact of lesion characteristics, particularly length, on procedural outcomes.
- To determine the restenosis rates following rotational coronary atherectomy.
Main Methods:
- Retrospective analysis of 42 patients undergoing Rotablator atherectomy.
- Inclusion criteria: suboptimal candidates for balloon angioplasty.
- Assessment of procedural success, complications, and angiographic restenosis.
- Correlation of outcomes with lesion length (≤1 cm vs. >1 cm).
Main Results:
- Procedural success was achieved in 76% of patients.
- Success rates were higher for lesions ≤1 cm (92%) versus >1 cm (70%) (p<0.01).
- Longer lesions were associated with increased rates of non-Q wave myocardial infarction (19%) and restenosis (75% vs. 22%).
Conclusions:
- High-speed rotational coronary atherectomy (Rotablator) is feasible in selected patients.
- Lesion length is a critical factor influencing procedural success and long-term restenosis.
- Rotablator outcomes are significantly poorer for longer coronary lesions.
Abstract:
High speed rotational coronary atherectomy was undertaken using the Rotablator in 42 patients who were suboptimal candidates for balloon angioplasty. Most patients (71%) had diffuse coronary artery disease, defined as a stenosis greater than 1 cm in length. Previous restenosis after balloon angioplasty was present in 21% and 10% had an ostial lesion. Adjunctive balloon angioplasty was not used to reduce residual stenosis after atherectomy. The procedure was successful in 76% of patients. Procedural success was achieved in 92% of patients with a lesion less than or equal to 1 cm in length, but in only 70% of patients with a lesion greater than 1 cm in length (p less than 0.01). One patient sustained abrupt closure of the target vessel, resulting in emergency bypass surgery and death. Small non-Q wave myocardial infarction occurred in eight patients (19%) and was associated with a longer lesion. The mean peak creatine kinase value in patients with non-Q wave myocardial infarction was 683 U/liter. Transient regional wall motion abnormalities were noted on the postatherectomy left ventricular angiogram in four of the eight patients with non-Q wave myocardial infarction. Follow-up angiography (at a mean interval of 6.2 +/- 2.6 months) was performed in 91% of patients and revealed restenosis (greater than 50% narrowing) in 59% The resistance rate was 22% for short lesions (less than or equal to 1 cm) and 75% for long lesions (greater than 1 cm) (p less than 0.05). In this study, the results of high speed rotational coronary atherectomy were strongly influenced by lesion length.(ABSTRACT TRUNCATED AT 250 WORDS)