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Impact of restenosis after optimal directional coronary atherectomy on regional left ventricular function
P Coste1, S Sempé, P Dos Santos
1Catheterization Laboratory, IFR Coeur-Vaisseaux-Thrombose, University of Bordeaux II, Bordeaux-Pessac, France.
Insights
Optimal directional coronary atherectomy (DCA) shows a low restenosis rate and can improve left ventricular (LV) function, especially in left anterior descending artery disease without restenosis.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Medical Imaging
Background:
- Coronary artery disease necessitates effective revascularization strategies.
- Restenosis and impact on left ventricular (LV) function remain critical concerns after interventions.
Purpose of the Study:
- To evaluate the efficacy of optimal directional coronary atherectomy (DCA) in reducing restenosis.
- To assess the effect of DCA on left ventricular (LV) function post-procedure.
Main Methods:
- Prospective follow-up of 95 patients undergoing DCA and balloon angioplasty for de novo lesions.
- Quantitative coronary angiography for lumen measurements and LV cineangiograms for functional analysis.
- Analysis of restenosis rates and LV volumes, ejection fraction, and segmental wall motion at 6 months.
Main Results:
- Mean lumen diameter significantly improved post-DCA, with 14% residual stenosis.
- Overall angiographic restenosis rate was 23% at 6 months.
- In patients without restenosis, LV function improved, particularly ejection fraction and fractional shortening in the left anterior descending artery group.
Conclusions:
- Optimal DCA is effective in achieving low restenosis rates in selected large coronary vessels.
- DCA can lead to long-term beneficial effects on regional LV function, especially in left anterior descending artery disease without restenosis.
Abstract:
To assess the effect of optimal directional coronary atherectomy (DCA) on restenosis and left ventricular (LV) function, 95 patients who underwent DCA and adjunctive balloon angioplasty for de novo lesions were prospectively followed for 6 months. Absolute and relative coronary lumen measurements were analyzed with online quantitative coronary angiography. LV volumes, ejection fraction, and segmental wall motion were measured off-line according to the radial method for LV cineangiograms acquired in a right anterior oblique projection. Target vessels were the left anterior descending artery in 63 patients and right coronary artery in 32. Mean (+/- SD) reference diameter was 3.58 +/- 0.65 mm. Mean lumen diameter improved significantly after DCA from 1.19 +/- 0.44 to 3.03 +/- 0.45 mm, yielding a 14 +/- 10% residual stenosis. Overall angiographic restenosis rate (> 50% stenosis in diameter) at control was 23%. In patients without restenosis, there were no significant changes in LV volumes or in LV pressures. In this subgroup, ejection fraction improved significantly in the left anterior descending group (mean difference 3 +/- 10%, p < 0.04). Moreover, there was an increase in fractional shortening of all anterior segments (mean difference 11 +/- 16%, p < 0.005). Improvement in fractional shortening was less marked in the right coronary artery group even without restenosis. We conclude that: (1) optimal DCA can achieve a low restenosis rate in selected large vessels, (2) long-term beneficial effects on regional LV function are possible, particularly in patients with left anterior descending disease and in the absence of coronary restenosis.