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[Directional coronary atherectomy after unsuccessful angioplasty]
R Villavicencio1, A Arceo, H Meléndez
1Instituto Nacional de Cardiología "Ignacio Chávez", Departamento de Hemodinámica, Tlalpan, México, D.F.
Insights
Directional coronary atherectomy (DCA) offers a viable solution for complex coronary lesions when conventional angioplasty fails. This study highlights successful "rescue" DCA cases, demonstrating its effectiveness in treating residual stenosis caused by elastic recoil.
Area of Science:
- Interventional Cardiology
- Cardiovascular Surgery
Background:
- Directional coronary atherectomy (DCA) is a percutaneous revascularization technique.
- Indications include complex coronary lesions like excentricity, ulceration, and non-calcified lesions in large vessels or vein grafts.
Observation:
- DCA has proven useful when conventional coronary angioplasty fails.
- Specific scenarios include acute occlusions, threatened closure, elastic recoil, focal dissection, or residual stenosis >50% from plaque.
Findings:
- Two cases of "rescue" DCA are presented for residual stenosis >50% due to elastic recoil.
- One case involved a concentric lesion; the other had marked eccentricity.
- Both cases achieved primary success, with atheroma confirmed by histopathology.
Implications:
- Rescue DCA is a valuable and feasible alternative for selected patients.
- It provides a successful treatment option when initial conventional angioplasty is unsuccessful.
Abstract:
Directional coronary atherectomy (DCA) is a percutaneous revascularization procedure. The basic indications are complex lesions (excentricity, irregular borders with ulceration and in non-calcified lesions in large coronary vessels or in vein grafts). DCA in recent years has been a useful procedure in several circumstances, in which initial results with conventional coronary angioplasty had failed, specifically in those conditions like acute occlusions, threatened closure or "elastic recoil" phenomenal, focal dissection or residual stenosis > 50% due to hare atherosclerotic plaque. In this report two cases of "rescue" DCA due to residual stenosis > 50% because of "elastic recoil" are presented. One of them had a concentric lesion and the other a marked excentricity. Both cases had primary success. Atheroma was shown by histopathology. Rescue DCA is a useful feasible alternative procedure in selected cases, in which conventional coronary angioplasty had initially not been successful.