High speed rotational coronary atherectomy for patients with diffuse coronary artery disease

Abstract

High speed rotational coronary atherectomy was undertaken using the Rotablator in 42 patients who were suboptimal candidates for balloon angioplasty. Most patients (71%) had diffuse coronary artery disease, defined as a stenosis greater than 1 cm in length. Previous restenosis after balloon angioplasty was present in 21% and 10% had an ostial lesion. Adjunctive balloon angioplasty was not used to reduce residual stenosis after atherectomy. The procedure was successful in 76% of patients. Procedural success was achieved in 92% of patients with a lesion less than or equal to 1 cm in length, but in only 70% of patients with a lesion greater than 1 cm in length (p less than 0.01). One patient sustained abrupt closure of the target vessel, resulting in emergency bypass surgery and death. Small non-Q wave myocardial infarction occurred in eight patients (19%) and was associated with a longer lesion. The mean peak creatine kinase value in patients with non-Q wave myocardial infarction was 683 U/liter. Transient regional wall motion abnormalities were noted on the postatherectomy left ventricular angiogram in four of the eight patients with non-Q wave myocardial infarction. Follow-up angiography (at a mean interval of 6.2 +/- 2.6 months) was performed in 91% of patients and revealed restenosis (greater than 50% narrowing) in 59% The resistance rate was 22% for short lesions (less than or equal to 1 cm) and 75% for long lesions (greater than 1 cm) (p less than 0.05). In this study, the results of high speed rotational coronary atherectomy were strongly influenced by lesion length.(ABSTRACT TRUNCATED AT 250 WORDS)

Assessment of the Histological Characteristics of Coronary Arterial Plaque With Severe Calcification

“…[1][2][3][4] During ablation of the plaque, microparticles are produced by the advancing burr and experimental studies suggested that these particles pass harmlessly through the distal microcirculation. 10,19 However, several clinical studies have shown that RA is associated with higher rates (6-15%) of the no-reflow/slow-flow phenomenon than other coronary revascularization procedures, [5][6][7][8][9] and this phenomenon can lead to serious ischemic complications, such as conduction disturbances, myocardial infarction, cardiogenic shock or even death.…”

Acute and late clinical outcome after rotational atherectomy for complex coronary disease

“…Among the many new devices now in use, rotational atherectomy is unique in its ability to mechanically ablate hard fibro-calcific tissue without inducing significant trauma to less diseased vessel segments [1][2][3][4][5]. In contrast to other atherectomy devices which are limited by vessel size and rigidity, PTCRA is well-suited for use in a variety of arteries including those that are diffusely diseased, calcified, and small in caliber; vessels not effectively treated with balloon angioplasty or stents [1,5,7,18].…”

“…However, non-randomized reports demonstrate that PTCRA can be performed safely and with a high degree of success in both simple and complex coronary disease [7][8][9]12,[14][15][16][17][18]31,32]. The PTCRA Registry demonstrated Ͻ2% incidence of emergent bypass and Ͻ1% incidence of Q wave infarction and death [17].…”

Detailed angiographic analysis of high-speed mechanical rotational atherectomy in human coronary arteries.

“…However, experimental studies suggest that microparticle dimensions are dependent on the size of the burr and the speed of rotation, and it is generally assumed that in human coronary use, the majority of microparticles are less than 5 gm in diameter.12 Al-though particles of this size should pass harmlessly into the microcirculation, distal embolization leading to myocardial infarction has been reported. 13 The relative contribution of tissue pulverization versus the "Dotter" effect (mechanical dilation of the lesion) is unknown.…”