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High-speed rotational atherectomy: six-month serial quantitative coronary angiographic follow-up
S H Stertzer1, E V Pomerantsev, P J Fitzgerald
1Stanford University Hospital, Palo Alto, CA 94304, USA.
Insights
High-speed rotational atherectomy (HSRA) improved lesion characteristics and reduced restenosis. Patients showed increased focal concentric lesions and decreased type C lesions post-HSRA, with a low 6% restenosis rate.
Area of Science:
- Cardiovascular Interventions
- Interventional Cardiology
- Vascular Biology
Background:
- High-speed rotational atherectomy (HSRA) is a percutaneous coronary intervention technique.
- Atherectomy aims to debulk atherosclerotic plaque, improving luminal dimensions.
- Understanding long-term lesion modification and restenosis rates after HSRA is crucial for patient outcomes.
Purpose of the Study:
- To evaluate the long-term effects of HSRA on lesion morphology.
- To assess the relationship between initial gain and late lumen loss after HSRA.
- To determine the restenosis rate following HSRA.
Main Methods:
- Retrospective analysis of 123 patients undergoing HSRA.
- Follow-up assessment at 6.9 +/- 1.2 months.
- Comparison of lesion types (focal concentric vs. type C) and analysis of net gain (NG) and minimal luminal diameter (MLD).
Main Results:
- Focal concentric lesions increased significantly (32.2% to 63.0%, p<0.01), while type C lesions decreased (54.8% to 30.8%, p<0.05).
- Higher baseline lesions were observed in the high-gain group (NG >20%) compared to moderate-gain and loss groups.
- The high NG group demonstrated the highest initial gain and lowest late loss, associated with a 6% restenosis rate.
Conclusions:
- HSRA effectively modifies atherosclerotic lesions, leading to improved morphology.
- Higher initial gain after HSRA correlates with better long-term outcomes and reduced late lumen loss.
- A strong interaction between the atherectomy burr and atheroma is linked to a low restenosis rate.
Abstract:
One hundred twenty-three patients treated with high-speed rotational atherectomy (HSRA) were restudied 6.9 +/- 1.2 months later. At the follow-up, the number of focal concentric lesions increased from 32.2 percent to 63.0 percent, p<0.01, with decrease of type C lesions from 54.8 percent to 30.8 percent, p<0.05. Comparison of the degree of the net gain (NG) showed more severe baseline lesions in the high-gain group (NG >20 percent) compared with the moderate-gain group (20 percent > NG > 0 percent) and to the loss group (minimal luminal diameter [MLD] 0.8 +/- 0.4 mm vs 1.0 +/ 0.4 mm, p<0.05; and 1.2 +/- 0.5 mm; p<0.01, respectively). Highest initial gain (36.5 percent +/- 26.2 percent vs 24.5 percent +/- 18.1 percent; p<0.015; and 19.0 percent +/- 23.2 percent; p<0.001) as well as lowest late loss (1.8 percent +/- 21.7 percent vs 14.0 percent +/-18.4 percent; p<0.01 and 28.1 percent +/- 25.0 percent; p<0.01) were found in the high NG group. A higher interaction between burr and atheroma resulted in the lowest restenosis rate of 6 percent.