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Coronary atherectomy versus angioplasty: the CAVA Study
H Feld1, N Schulhoff, E Lichstein
1Maimonides Medical Center, Department of Medicine, SUNY Health Science Center, Brooklyn, NY 11219.
Insights
Directional coronary atherectomy offers a larger lumen and fewer dissections than angioplasty, but with a higher complication rate. Both procedures show similar long-term restenosis rates for suitable coronary lesions.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Medical Device Technology
Background:
- Directional coronary atherectomy (DCA) was developed to improve upon percutaneous transluminal coronary angioplasty (PTCA) by aiming for a larger, smoother lumen and reducing dissections.
- The hypothesis was that DCA would lower risks of acute closure and restenosis compared to PTCA.
Purpose of the Study:
- To compare the clinical and angiographic outcomes of DCA versus PTCA in well-matched patient groups.
- To evaluate procedural success, complications, and long-term restenosis rates.
Main Methods:
- A comparative study of 126 DCA procedures and 127 PTCA procedures on similar coronary lesions.
- Evaluation of procedural results including dissections, complications, acute closure, and residual stenosis.
- Follow-up at 6 months for recurrent angina, repeat catheterization, and angiographic restenosis.
Main Results:
- Both DCA and PTCA demonstrated high angiographic success rates (99% and 98%, respectively).
- DCA resulted in significantly fewer dissections (13% vs. 22%) and less residual stenosis (8.3% vs. 15%) compared to PTCA (p < 0.05).
- DCA was associated with a higher complication rate (p = 0.03), with a trend towards more occlusions.
Conclusions:
- DCA and PTCA offer high procedural success rates for appropriate coronary lesions.
- While DCA provides a larger residual lumen and fewer dissections, it carries a higher complication risk than PTCA.
- No significant differences were observed in angina recurrence or 6-month restenosis rates between the two techniques.
Abstract:
Directional coronary atherectomy was developed with the hope that it would lower the risk of acute closure and restenosis by leaving a larger smoother lumen and fewer dissections than angioplasty. To evaluate this hypothesis, we compared the clinical and angiographic results of directional coronary atherectomy with those of percutaneous transluminal coronary angioplasty in well-matched groups. We studied 126 consecutive atherectomies and 127 angioplasties performed on similar lesions. Procedural results were evaluated with regard to dissections, complications, acute closure, and residual stenosis. Each patient's clinical course was followed, and each patient was contacted at 6 months for evaluation of recurrent angina, need for repeat catheterization, and angiographic rate of restenosis. Baseline clinical and angiographic characteristics of the two groups were well matched and met the criteria established as being appropriate for atherectomy. The angiographic success rate was 98% after angioplasty and 99% after atherectomy. There were fewer dissections after atherectomy (13%) compared with the number after angioplasty (22%; p = 0.03). Residual stenosis was 8.3 +/- 9% after atherectomy compared with 15 +/- 12% after angioplasty (p = 0.0001). However, there were more complications after atherectomy (p = 0.03). There was no significant difference between the two groups in the recurrence rate of angina or in the angiographic restenosis rate at 6 months. It was concluded that when lesion characteristics and vessel size are appropriate for atherectomy, the procedural success rate of either atherectomy or angioplasty is extremely high. Although atherectomy leads to a larger residual lumen and fewer dissections, the complication rate after atherectomy is higher than that after angioplasty. There is a trend toward more occlusions after atherectomy.(ABSTRACT TRUNCATED AT 250 WORDS)