[Alternative methods in interventional therapy of coronary heart disease]

Percutaneous high-frequency coronary rotablation using the rotablator is able to remove arteriosclerotic material from the vessel wall. A diamond-coated (30-80 microns) brass burr drill fastened to a flexible drive shaft rotating and tracking along a drill coaxial guide wire is used. The turbine rotates the drive shaft in excess of 150,000-190,000 rpm. High-frequency rotational angioplasty was successful in > 90% of patients, but in about 90% additional PTCA is necessary. No increase of bypass surgery compared to PTCA is observed. CK and CR-MB elevation is more often found than after PTCA. Vessel perforation is rarely observed. All vessels were open at 24-h control. The restenosis rate seems not be increased. The main indications for high-frequency rotational angioplasty are rigid and calcified sclerotic lesions which cannot be passed by conventional balloon catheters. Whether the restenosis rate can be reduced by this method will be judged in part by the COBRA study. In order to avoid acute complications of PTCA and to reduce restenosis rate, coronary stents were developed. Self-expandable and balloon expandable stents are available. It could be demonstrated that these stents can be used as a bail-out system and can block elastic recoil of coronary arteries. The major remaining problem is subacute closure of coronary vessels. In order to prevent thrombosis treatment with coumarine, acetylsalicylic acid, and dipyridamol is necessary. Coronary stents can be successfully delivered in more than 90% of the patients. In a highly selected patient group using single stents restenosis rate could be significantly reduced.