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[Directional coronary atherectomy: effect of vessel size on primary results and long-term results]
S I Muurling1, M Lins, E Nagel
1Klinik für Kardiologie, I. Medizinischen Universitätsklinik, Christian-Albrechts-Universität, Kiel.
Insights
Directional coronary atherectomy (DCA) effectively treats coronary stenoses in patients with different reference vessel diameters. This study shows DCA provides satisfying long-term results with comparable restenosis rates and low complications across patient subgroups.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Vascular Surgery
Background:
- Directional coronary atherectomy (DCA) is an established percutaneous coronary intervention technique.
- Patient selection and procedural parameters may influence DCA outcomes.
- Long-term efficacy and safety data stratified by reference vessel diameter are valuable.
Purpose of the Study:
- To evaluate the long-term efficacy and safety of DCA in treating coronary stenoses.
- To compare outcomes between patients with different initial reference vessel diameters (RD).
Main Methods:
- Retrospective analysis of 263 patients with 277 stenoses treated with DCA.
- Patients divided into two groups based on RD: Group I (RD > 3 mm) and Group II (RD ≤ 3 mm).
- Quantitative coronary angiography assessed minimal luminal diameter (MLD), diameter stenosis (%D), and RD pre-DCA, post-DCA, and at 3-6 months follow-up (FU).
Main Results:
- Successful DCA treatment achieved in 263 patients with a 3-6 month angiographic FU.
- Restenosis rates at FU were 20.6% in Group I and 28.0% in Group II (p: n.s.).
- No significant differences in complications were observed between the groups.
Conclusions:
- DCA demonstrates satisfying long-term results for coronary stenoses.
- Efficacy and safety of DCA are comparable between patients with reference diameters >3 mm and ≤3 mm.
- DCA is a safe and effective treatment option for a broad range of coronary artery lesions.
Abstract:
Of 325 consecutive patients undergoing DCA, 263 patients with 277 stenoses were successfully treated with DCA alone and had angiographic follow-up 3-6 months later. Depending upon the initial reference diameter (RD) patients were divided into two subgroups: group I (n = 159) with a RD > 3 mm and group II (n = 104) showing a RD < or = 3 mm. In contrast to other series DCA was predominantly performed with 7F atherectomy devices using balloon inflation pressures of approximately 5 atm. Angiographic data including the minimal luminal diameter (MLD), percentage of stenosis (%D) and reference diameter (RD) were assessed by quantitative computer-assisted analysis before (pre), after (post) DCA and at a 3-6 months angiographic follow-up (FU). The percentage of diameter stenosis pre/post/FU in group I was 59.9 +/- 12.6%/18.4 +/- 12.8%/29.8 +/- 17.6%, and in group II 55.6 +/- 10.8%/17.8 +/- 12.3%/33.7 +/- 16.1% with a net gain at FU of 1.0 +/- 0.89 mm for group I and 0.86 +/- 0.66 mm for group II. Based on an angiographic restenosis criterion of at least 50% diameter obstruction at FU and or recurrence of symptoms warranting interventional re-treatment of the target lesion, the incidence of restenosis in group I was 20.6% and in group II 28.0% (p: n.s.). There was no significant difference between the two groups concerning complications. Our data show that DCA leads to a satisfying long-term result.(ABSTRACT TRUNCATED AT 250 WORDS)