Related Experiment Videos
Outcome of narrowing related side branches after high-speed rotational atherectomy
A S Walton1, E V Pomerantsev, S N Oesterle
1Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA.
Insights
High-speed rotational atherectomy (HSRA) rarely causes side branch occlusion, with most occlusions being temporary. While infrequent, side branch occlusion after HSRA can lead to myocardial infarction.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Medical Imaging
Background:
- High-speed rotational atherectomy (HSRA) is a key treatment for complex coronary artery disease.
- Significant side branches in target lesions are a concern during HSRA.
- Existing guidelines consider significant side branches a relative contraindication for HSRA.
Purpose of the Study:
- To investigate the incidence of side branch occlusion following HSRA.
- To identify predictors of side branch occlusion after HSRA.
- To evaluate the clinical outcomes associated with side branch occlusion post-HSRA.
Main Methods:
- Retrospective analysis of 418 patient angiograms undergoing HSRA.
- Identification and assessment of 320 side branches in 240 target vessels.
- Quantitative angiographic analysis of 108 side branches, including occluded ones.
- Clinical outcome assessment for patients experiencing side branch loss.
Main Results:
- A 7.5% rate of side branch occlusion was observed in 21 out of 418 patients.
- Follow-up angiography showed 12 out of 13 occluded branches remained patent.
- Patients with branch occlusion had a 29% incidence of myocardial infarction.
Conclusions:
- Side branch occlusion after HSRA is infrequent and often transient.
- HSRA can be safely performed in vessels with lesion-associated side branches.
- Careful assessment and management are crucial when side branches are present during HSRA.
Abstract:
High-speed rotational atherectomy (HSRA) is advocated for calcified and diffusely narrowed coronary arteries. There are often side branches involving these kinds of lesions. The presence of significant lesion-related side branches has been considered a relative contraindication to rotational atherectomy. This study was performed to determine the rate, predictors, and outcome of side branch occlusion after HSRA. The angiograms of 418 patients were examined with 320 side branches in 240 target vessels of > or = 1 mm in diameter being identified. Vessels were scored as either perfused (Thrombolysis In Myocardial Infarction 2 or 3 flow) or occluded (Thrombolysis In Myocardial Infarction 0 or 1 flow before and after the procedure. A detailed quantitative angiographic analysis was performed on a total of 108 side branches including all cases of branch occlusion. Clinical outcomes were determined in all cases with side branch loss. There were 24 occlusions in 21 patients after the procedure, giving a rate of branch loss of 7.5%. Follow-up angiography of > or = 24 hours was available for 13 of the occluded branches and 12 were found to be patent. In the 21 patients with branch occlusion, 6 sustained a myocardial infarct (of which 5 were non-Q-wave), 2 underwent coronary artery bypass grafting, and 2 died. There are frequently lesion-associated side branches in the types of vessels to undergo HSRA. These branches remained patent 92.5% of the time, with occlusion occurring infrequently and usually being transient. When occlusion did occur, there was a 29% incidence of myocardial infarction.