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[Restenosis after optimal coronary atherectomy and influence on left ventricular function]
P Coste1, P Dos Santos, S Sempe
1IFR Coeur-Vaisseaux-Thrombose Inserm 4, CNRS FR21, service de soins intensifs et de cardiologie interventionnelle.
Insights
Optimal atherectomy shows a 23% restenosis rate at 6 months. Patients without restenosis experienced improved left ventricular function, particularly after left anterior descending artery procedures.
Area of Science:
- Interventional Cardiology
- Cardiovascular Imaging
- Vascular Biology
Context:
- Atherectomy is a procedure to remove plaque from arteries.
- Restenosis, the re-narrowing of an artery, is a common complication after interventions.
- Assessing outcomes of optimal atherectomy is crucial for patient management.
Purpose:
- To evaluate the incidence of restenosis after optimal guided atherectomy at 6 months.
- To assess the impact of atherectomy on left ventricular function and segmental wall motion.
Summary:
- 95 patients underwent atherectomy (63 LAD, 32 RCA), with quantitative angiography measuring lesion diameter and stenosis.
- Atherectomy increased minimal lumen diameter and reduced stenosis. At 6 months, 23% of patients experienced restenosis (>50% stenosis).
- In patients without restenosis, global ejection fraction increased (+4%), and anterior segmental wall motion improved (+11%), especially after LAD atherectomy.
Impact:
- Optimal atherectomy demonstrates acceptable restenosis rates.
- Medium-term benefits in segmental wall motion are observed in patients without restenosis, particularly those treated on the left anterior descending artery.
Abstract:
The authors prospectively assessed 95 patients undergoing optimal guided atherectomy to assess the incidence of restenosis at 6 months. The coronary lesions were measured by a system of quantitative angiography to ensure reproducibility. Ventricular volumes, ejection fraction and segmental wall motion were assessed by ventriculography performed in the right anterior oblique projection. Sixty-three patients underwent atherectomy of the left anterior descending artery and 32 patients of the right coronary artery. The reference diameter was 3.58 +/- 0.65 mm. Atherectomy increased the minimal diameter of the lesion from 1.19 +/- 0.44 to 3.03 +/- 0.45 mm, with a residual stenosis of 14 +/- 10% of the diameter. At 6 months, 23% of patients had restenosed (> 50% stenosis) with a residual lumen at 1.16 +/- 0.39 mm. In the absence of restenosis, there was no significant change in left ventricular volumes or pressures and the global ejection fraction increased by +4 +/- 9% (p < 0.01), mainly in the group undergoing left anterior descending atherectomy. Moreover, fractional shortening increased in the anterior segments (+11 +/- 18%; p < 0.001). The authors conclude that optimal atherectomy is associated with acceptable rates of restenosis and that medium-term benefits of segmental wall motion are observed in patients without angiographic restenosis, mainly in those undergoing the procedure on the left anterior descending artery.