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Combined percutaneous coronary atherectomy and coronary angioplasty: experience in 19 consecutive patients
M R Bell1, U P Kaufmann, R E Vlietstra
1Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905.
Insights
Combined coronary atherectomy and angioplasty in 19 patients showed a 79% success rate. This combined intervention is a safe and effective approach for selected patients with coronary artery disease complications.
Area of Science:
- Cardiology
- Interventional Cardiology
Background:
- Coronary atherectomy and angioplasty are common interventions for coronary artery disease.
- Combined procedures may offer benefits in complex cases.
Purpose of the Study:
- To evaluate the safety and effectiveness of combined coronary atherectomy and angioplasty.
- To analyze outcomes based on the sequence of interventions.
Main Methods:
- Retrospective analysis of 19 patients who underwent combined coronary atherectomy and angioplasty.
- Categorization of patients based on whether atherectomy preceded or followed angioplasty.
Main Results:
- The overall success rate for the combined intervention was 79%.
- Success rates were 82% when atherectomy preceded angioplasty and 75% when it followed.
- Complications included one in-hospital death, one non-Q wave infarction, and three patients requiring coronary artery surgery.
Conclusions:
- Combined coronary atherectomy and angioplasty is a relatively safe and effective strategy for selected patients.
- This approach is particularly useful when single interventions are unsuccessful or complicated by acute coronary events.
Abstract:
Among 82 patients undergoing coronary atherectomy, 19 (23%) underwent this procedure in combination with coronary angioplasty. The most frequently involved vessel was the left anterior descending coronary artery. In 11 patients (58%), attempted atherectomy preceded coronary angioplasty. In 6 of the 11, angioplasty was used after the atherectomy catheter could not be positioned across the lesion; 4 patients underwent "rescue" angioplasty after developing vessel occlusion related to atherectomy and 1 patient had an unsatisfactory result of atherectomy. The success rate of the combined intervention was 82% for these 11 patients. In eight patients (42%), atherectomy was performed after initial angioplasty. In four of the eight, atherectomy was a rescue procedure to manage vessel occlusion by thrombus or intimal dissection and was successful in three. In the other four, angioplasty was performed to establish an easier passage for the atherectomy catheter and was successful in three. Thus, the success rate of the combined intervention was 75% for these eight patients. The overall success rate for all 19 patients was 79%; there was one in-hospital death and one non-Q wave infarction, and one patient required immediate coronary artery surgery. Two other patients underwent coronary artery surgery before hospital discharge. Combined intervention with coronary angioplasty and atherectomy seems to be a relatively safe and effective approach in selected patients when either of these procedures alone is unsuccessful or is accompanied by acute coronary complications.