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Directional atherectomy of aorto-ostial stenoses
P M Kerwin1, L S McKeever, J C Marek
1Midwest Cardiovascular Institute, Midwest Heart Research Foundation, Lombard, Illinois.
Insights
Directional coronary atherectomy (DCA) offers a successful alternative for treating aorto-ostial right coronary artery (RCA) and saphenous vein graft (SVG) stenoses. This interventional cardiology technique achieved high acute success rates and favorable outcomes in patients with significant arterial narrowing.
Area of Science:
- Interventional Cardiology
- Vascular Surgery
- Cardiovascular Disease
Background:
- Balloon angioplasty for aorto-ostial right coronary artery (RCA) and saphenous vein graft (SVG) stenoses has suboptimal outcomes.
- These limitations include lower acute success, higher restenosis rates, and increased need for emergency bypass surgery.
Purpose of the Study:
- To evaluate directional coronary atherectomy (DCA) as an alternative treatment for aorto-ostial RCA and SVG stenoses.
- To assess the acute success and follow-up outcomes of DCA in this patient cohort.
Main Methods:
- Retrospective analysis of 23 patients with >60% stenosis within 3mm of RCA or SVG origin.
- Directional coronary atherectomy (DCA) was performed, with quantitative angiography measuring stenosis reduction.
- Follow-up included exercise treadmill testing and/or repeat cardiac catheterization.
Main Results:
- DCA achieved high acute success: 93% for RCA ostial lesions and 100% for SVG lesions.
- Mean stenosis reduction was significant: from 87% to 9% for RCA and 85% to 8% for SVG.
- Overall restenosis rate was 14% (3/22 patients); angiographic restenosis was 25% for RCA and 50% for SVG lesions.
Conclusions:
- Directional coronary atherectomy (DCA) is technically feasible for aorto-ostial stenoses.
- DCA demonstrates good initial technical success and acceptable clinical outcomes.
- DCA represents a viable alternative to balloon angioplasty in specific aorto-ostial lesion subsets.
Abstract:
Balloon angioplasty of aorto-ostial right coronary artery (RCA) and aorto-ostial saphenous vein graft (SVG) stenoses has been reported to be associated with a suboptimal acute success rate, a higher incidence of restenosis and an increased risk of emergent coronary artery bypass surgery. In this report, we describe the use of directional coronary atherectomy (DCA) as a treatment alternative in a series of twenty three patients who were documented to have a > 60% stenosis within 3 mm of the origin of the RCA (15 patients) or SVG (8 patients) as measured by on-line quantitative angiography. DCA was successfully performed in 14 of 15 RCA ostial lesions and in all eight SVG lesions. This yielded an acute success rate of 93% and 100% with a mean reduction in percent stenosis from 87% to 9% and from 85% to 8% respectively. Only one patient, presenting with an ostial RCA lesion, was unable to be revascularized using DCA. All successfully treated patients underwent exercise treadmill testing or repeat cardiac catheterization in follow-up. Clinical evidence of restenosis defined as recurrent chest pain or ischemic evidence on exercise treadmill and > 50% angiographic restenosis was demonstrated in three of twenty two patients (14%). Of the nine successfully treated patients who underwent repeat cardiac catheterization, three (33%) had restenosed for an angiographic rate of 25% for RCA and 50% for SVG lesions. In conclusion, DCA of aorto-ostial stenoses is technically feasible and can be performed with good initial results.(ABSTRACT TRUNCATED AT 250 WORDS)