Related Experiment Videos
Immediate results of interventional devices for coronary ostial narrowing with angina pectoris
M N Sabri1, M J Cowley, G DiSciascio
1Cardiac Catheterization Laboratory, Medical College of Virginia, Richmond.
Insights
New debulking devices like atherectomy and excimer laser show improved results for aorto-ostial lesions compared to angioplasty alone. These devices achieve greater acute gain with a high success rate, even in complex cases.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
Background:
- Aorto-ostial lesions historically present suboptimal outcomes with conventional angioplasty.
- Newer debulking technologies offer potential for improved treatment efficacy.
Purpose of the Study:
- To evaluate the immediate results of novel debulking devices (atherectomy, excimer laser) versus angioplasty alone for aorto-ostial lesions.
- To compare procedural success and acute gain between treatment groups.
Main Methods:
- Retrospective comparison of 31 vessels (new devices, group I) versus 15 vessels (angioplasty alone, group II).
- Analysis of procedural success, acute gain (reduction in percent stenosis), and complications.
- Inclusion of vessels with unfavorable angiographic features for angioplasty in group I.
Main Results:
- Procedural success rates were similar (91% group I vs. 93% group II).
- New devices demonstrated significantly greater acute gain (66% directional atherectomy, 67% rotational atherectomy) compared to angioplasty (46%).
- Group I had a higher prevalence of unfavorable lesion characteristics but an acceptable complication rate (6% requiring bypass).
Conclusions:
- New debulking devices achieve high procedural success rates (>90%) and significantly larger acute gain in aorto-ostial lesions.
- These devices are effective even in the presence of unfavorable angiographic features.
- Further studies are required to assess long-term outcomes, specifically restenosis rates.
Abstract:
Angioplasty of aorto-ostial lesions has had suboptimal results. This study reports on the immediate results of new debulking devices (atherectomy, excimer laser) in the treatment of aorto-ostial disease. Thirty-one vessels (29 patients) with an ostial lesion treated with a new device (group I) were compared with 15 vessels (13 patients) with an ostial lesion treated with angioplasty alone during the preceding 24 months (group II). Both groups were similar in their clinical characteristics. A larger proportion of vessels in group I (64%) compared with group II (7%) had unfavorable features for angioplasty. Procedural success was similar: 28 vessels in group I (91%) and 14 in group II (93%). Among the new devices, success was also similar: atherectomy in 8 arteries (89%), rotablator in 4 (100%) and excimer laser in 17 (94%). The acute gain was more significant with new devices: absolute reduction in percent stenosis was 66% for directional atherectomy, 67% for rotational atherectomy (p = 0.016 compared with angioplasty), 52% for excimer laser (p = 0.09) and 46% for angioplasty. In group I, 2 patients (6%) required emergency bypass surgery during our early experience; no deaths or Q-wave myocardial infarctions occurred. Group II had no complications. Therefore in aorto-ostial lesions, despite a much higher prevalence of unfavorable angiographic characteristics, new devices had (1) a success rate of > or = 90%, (2) a significantly larger acute gain compared with angioplasty alone, and (3) an acceptable complication rate. Larger studies with complete angiographic follow-up are needed to assess restenosis.