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Initial report of rotational ablation: the Toronto Hospital experience
B P Kimball1, S D Lewis, D G Almond
1Department of Medicine, Division of Cardiology, The Toronto Hospital, Ontario, Canada.
Objective:
To describe the initial experience of rotational ablation (using the Rotablator device), in terms of safety and the effectiveness as a proportion of final angiographic outcome when combined with adjunctive balloon angioplasty.
Design:
Retrospective analysis of single-centre experience, including operator learning curve.
Setting:
Tertiary care hospital, Cardiac Catheterization Laboratory.
Patients:
Consecutive subjects (14 men, 11 women) selected for rotational ablation based on ostial/bifurcation lesions (n = 10), 'long' (more than 10 mm) stenoses (n = 11) or extensive dystrophic calcification (n = 4).
Interventions:
Rotational ablation (Rotablator) with routine adjunctive balloon angioplasty. Quantitative coronary arteriography using the Cardiac Measurement System.
Results:
Rotational ablation reduced coronary obstruction, as demonstrated by minimal lumen diameter (preprocedure, 0.57 =/- 0.28 to 1.17 +/- 0.32 mm, P<0.05), with further improvements following adjunctive balloon angioplasty (1.93 +/- 0.35 mm). Similar changes were observed in relative stenosis after Rotablator (preprocedure, 79.7 +/- 7.6 to 56.1 +/- 13.1% diameter), with typical post-angioplasty residual narrowings (29.7 +/- 8.2% diameter). Estimated stenotic flow reserve was improved by the interventional procedures (preprocedure, 0.94 +/- 0.70; rotational ablation 3.07 +/- 1.14; and angioplasty, 4.73 +/- 0.25 times baseline). Complications were acceptable, and included three acute occlusions requiring balloon angioplasty recanalization and three non-Q wave myocardial infarctions (with creatine phosphokinase levels of 270, 417 and 602 IU, respectively).
Conclusions:
The Rotablator is a relatively user-friendly device with a reasonable safety profile, accounting for approximately 50% of minimum lumen diameter gains when used in conjunction with routine balloon angioplasty. The precise role of rotational ablation, particularly in the context of preselected lesion specific uses (bifurcations, long lesions, dystrophic calcification), requires prospective, randomized studies.