Key result
High-speed rotational atherectomy for bifurcation lesions resulted in a 22.5% MACE rate versus 27.5% for balloon angioplasty at 15 months, a difference that did not reach statistical significance.
Why the study?
Does high-speed rotational atherectomy with provisional stenting improve procedural success and reduce MACE compared to balloon angioplasty in bifurcation-type coronary lesions?
Observational (n=150)
Does high-speed rotational atherectomy with provisional stenting improve procedural success and reduce MACE compared to balloon angioplasty in bifurcation-type coronary lesions?
High-speed rotational atherectomy with provisional stenting is a safe and effective alternative to balloon angioplasty for bifurcation coronary lesions, offering better acute angiographic results.
Answers are grounded in this paper and cite their sources.
Numerical MACE reduction with rotational atherectomy was nonsignificant; leaves open its benefit over balloon angioplasty in bifurcation lesions.
BACKGROUND: Bifurcational coronary lesions present a major interventional challenge. The differential cutting mechanism of high-speed rotational atherectomy (HSRA) may provide a favourable technique of treating this complex lesion subtype. METHODS: We evaluated the use of HSRA (32 lesions) compared to balloon angioplasty (BA) (118 lesions), with provisional stenting in both groups, in a non-randomised, retrospective study of 150 bifurcation-type lesions. RESULTS: The HSRA/stent group had a high primary success rate of 97%, an acceptably low in-hospital event rate of 9% and an overall major adverse cardiac event (MACE) rate at a mean follow-up period of 15 +/- 3.4 months of 22.5% with a target lesion revascularisation (TLR) rate of 18.7%. Procedural success in the BA/stent group was 81% with an in-hospital event rate of 14.4%, and the overall MACE rate at follow-up was 27.5% with a TLR rate of 23%. We achieved a greater acute gain in minimal luminal diameter and a lesser percentage of residual stenosis after intervention in the HSRA/stent group compared to the BA/stent group (p < 0.01). Outcome at follow-up favoured the HSRA/stent group, although the difference did not reach statistical significance. CONCLUSION: HSRA with provisional stenting provided a safe and effective means of treating bifurcation lesions.
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Nageh et al. (2001) conducted an observational in Bifurcation-type coronary lesions (n=150). High-speed rotational atherectomy (HSRA) with provisional stenting vs. Balloon angioplasty (BA) with provisional stenting was evaluated on Overall major adverse cardiac event (MACE). High-speed rotational atherectomy for bifurcation lesions resulted in a 22.5% MACE rate versus 27.5% for balloon angioplasty at 15 months, a difference that did not reach statistical significance.
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