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Rotational coronary atherectomy after unsuccessful coronary balloon angioplasty
W C Brogan1, J J Popma, A D Pichard
1Department of Internal Medicine (Cardiology Division), Washington Hospital Center, Washington, D.C. 20010.
Insights
Rotational coronary atherectomy effectively treats lesions resistant to balloon angioplasty, improving outcomes. This procedure ablates plaque, increasing vessel compliance and reducing stenosis for better coronary artery treatment.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Medical Devices
Background:
- Balloon angioplasty is a standard treatment for coronary artery disease.
- Some lesions are resistant to balloon angioplasty, necessitating alternative approaches.
- Rotational atherectomy is an option for complex or resistant coronary lesions.
Purpose of the Study:
- To evaluate the clinical and angiographic outcomes of rotational coronary atherectomy (RCA) after failed balloon angioplasty.
- To investigate the mechanism of benefit for RCA in such cases.
- To assess the safety and efficacy of RCA in a selected patient group.
Main Methods:
- Quantitative angiographic methods were used to assess lesion severity and procedural success.
- Retrospective analysis of 41 patients (50 lesions) treated with RCA after unsuccessful balloon angioplasty.
- Evaluation of diameter stenosis reduction, acute gain, and procedural complications.
Main Results:
- RCA reduced percent diameter stenosis from 72% to 41% (p < 0.001).
- Adjunct balloon angioplasty in 88% of lesions achieved a final stenosis of 25%.
- Angiographic success was 98% and procedural success was 90%, with a 7% complication rate.
Conclusions:
- Rotational coronary atherectomy is a viable option for selected patients with unsuccessful balloon angioplasty.
- The procedure's benefit may stem from improved plaque compliance via atheroma ablation.
- RCA offers a high rate of angiographic and procedural success in challenging coronary lesions.
Abstract:
The clinical and angiographic outcome of patients undergoing rotational coronary atherectomy after unsuccessful balloon angioplasty was evaluated using quantitative angiographic methods to provide insight into this procedure's mechanism of benefit. During the study period, 41 patients (50 lesions) were referred for rotational atherectomy after standard balloon angioplasty was unsuccessful. After rotational atherectomy, percent diameter stenosis was reduced from 72 +/- 14% to 41 +/- 16% (p < 0.001); adjunct balloon angioplasty was performed in 44 lesions (88%), resulting in a 25 +/- 17% final diameter stenosis (p < 0.001). The acute gain in minimal lumen diameter was 1.20 +/- 0.59 mm. In lesions needing adjunct balloon dilatation, lesion stretch was 73 +/- 27%, and elastic recoil was 22 +/- 18%, with no variation by etiology of the initial balloon failure. Overall angiographic success (< 50% residual diameter stenosis) was obtained in 49 lesions (98%). Procedural success, defined as < 50% residual diameter stenosis and the absence of major in-hospital complications (death, Q-wave myocardial infarction or emergency bypass surgery), was obtained in 37 of 41 procedures (90%); complications developed in 3 patients (7%), including 2 who needed emergency bypass surgery after development of delayed abrupt closure. It is concluded that rotational coronary atherectomy may be used in selected patients when standard balloon angioplasty is unsuccessful. Its mechanism of benefit appears related, at least in part, to changes in plaque compliance resulting from partial atheroma ablation.