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Directional atherectomy for the dilatation of bifurcation stenoses in the coronary arteries
D S Gambhir1, S Petkar, V Trehan
1Department of Cardiology, G. B. Pant Hospital, New Delhi.
Insights
Directional atherectomy effectively treats complex coronary artery bifurcation lesions, achieving high success rates with no major complications. This interventional cardiology technique offers a safe and successful option for patients with significant arterial narrowing.
Area of Science:
- Interventional Cardiology
- Vascular Surgery
- Cardiovascular Disease
Background:
- Coronary artery bifurcation lesions pose treatment challenges.
- Directional atherectomy is an emerging option for large artery bifurcation stenosis.
Purpose of the Study:
- To evaluate the immediate outcomes and acute complications of directional atherectomy for coronary artery bifurcation lesions.
- To assess the safety and efficacy of this technique in complex cases.
Main Methods:
- Retrospective analysis of 9 patients with true bifurcation stenoses (>70% narrowing).
- Utilized directional atherectomy, with double-wire technique in 4 patients.
- All patients underwent post-atherectomy balloon angioplasty, often with a side branch wire.
Main Results:
- Successful dilatation in 100% of patients.
- Significant reduction in stenosis: primary vessel from 93% to 6%, side branch from 83% to 13%.
- No major complications; minor complications included dissection, thrombus, distal branch occlusion, and guidewire entwinement.
Conclusions:
- Directional atherectomy is a safe and successful treatment for complex coronary artery bifurcation lesions.
- The double-wire or sequential atherectomy technique can be used without major adverse events.
- This method offers a viable alternative for challenging coronary artery stenoses.
Abstract:
Although bifurcation lesions in the coronary arteries can be dilated with balloon angioplasty, directional atherectomy is emerging as the treatment of choice in patients with large arteries. In this study, we report the immediate results and acute complications of treating bifurcation lesions in the coronary arteries with directional atherectomy in 9 patients, ranging in age from 33 to 60 (mean 56.7 +/- 10.8) years. All patients had true bifurcation stenoses with luminal diameter narrowing of more than 70 percent in both the primary vessel and the side branch. The lesions involved the left anterior descending (LAD)-diagonal system in 5, left circumflex (LCx)-obtuse marginal (OM) in 2, distal right coronary artery (RCA) in 1 and bifurcation of a large first diagonal branch in one patient. Double-wire atherectomy technique was used in 4 patients, although 7 had an additional wire in the side branch during post-atherectomy balloon angioplasty. The procedure was successful in all patients (100%), with luminal diameter stenosis decreasing from 93 +/- 7.5 percent to 6 +/- 8.6 percent in the primary vessel and from 83 +/- 9.2 percent to 13 +/- 9 percent in the side branch. There were no major complications. Minor complications included non-flow limiting dissection in 4 patients, distal migration of thrombus in one, occlusion of 2 small distal branches of the diagonal in one and entwinement of the guidewires in one. In conclusion, directional atherectomy can be performed safely and successfully for dilatation of complex bifurcation lesions in the coronary arteries without any major complications using the double-wire or sequential atherectomy technique.