Key result
DCA with stenting achieves ~13% angiographic restenosis in complex high-risk coronary lesions.
Why the study?
The use of stenting or directional coronary atherectomy alone for complex coronary lesions is associated with lowered success and high restenosis rates, motivating evaluation of their combined use.
Does directional coronary atherectomy combined with stenting improve procedural success and reduce restenosis in patients with complex coronary lesions?
Observational (n=60)
Does directional coronary atherectomy combined with stenting improve procedural success and reduce restenosis in patients with complex coronary lesions?
Directional coronary atherectomy prior to stenting is safe and associated with a low restenosis rate in high-risk patients with complex coronary lesions.
Answers are grounded in this paper and cite their sources.
Supports feasibility of atherectomy plus stenting in complex lesions; leaves open comparative efficacy versus stenting alone.
The purpose of this study was to determine the results of directional coronary atherectomy (DCA) combined with stenting in a high-risk patient population. The use of stenting or DCA alone for aorto-ostial lesions, total chronic occlusions, long lesions, and lesions containing thrombus is associated with lowered success and a relatively high restenosis rate. Between July 1993 and October 1996, we treated 89 lesions with the combined approach of DCA and stenting in 60 consecutive patients. Thirty-one (51.7%) patients were treated because of unstable angina, 11 (18.3%) for post-myocardial infarction (MI) angina, 3 (5.0%) for acute MI, and 15 (25.0%) patients for stable angina. A total of 43 (71.7%) patients had multivessel disease, 19 (31.7%) had undergone previous coronary artery bypass graft (CABG), and 17 (28.3%) patients had undergone multivessel revascularization. The procedure was successful in all patients; and no postprocedural deaths or emergent CABG occurred. Two patients (3.3%) had non-Q-wave MI after the procedure and 1 patient (1.7%) experienced Q-wave MI due to subacute stent closure 7 days after the procedure. During follow-up ranging from 6 months to 3 years, 2 (3.3%) patients died, 2 (3.3%) required CABG surgery, 1 (1.7%) patient had an MI, and 6 patients (10.0%) required target vessel revascularization. By the quantitative coronary angiography, the initial minimal luminal diameter (MLD) averaged 0.91+/-0.45 mm (74.7+/-11.8% stenosis) increasing to 3.80+/-0.44 mm (-6.7+/-12.1%) after the combined approach procedure. Thirty patients (50.0%) met criteria for late (> or =6 months) angiographic follow-up. Late MLD loss averaged 1.13+/-1.07 mm, for a mean net gain of 1.61+/-1.23 mm. Available angiographic follow-up evaluation showed a restenosis rate of 13.3%. A combined approach, defined as the use of both DCA and stenting, is safe and yields a low restenosis rate in high-risk patients who have lesions known to respond less favorably to stenting or DCA alone.
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Kiesz et al. (1998) conducted an observational in Complex coronary lesions (n=60). Directional coronary atherectomy (DCA) combined with stenting was evaluated on Angiographic restenosis rate. Directional coronary atherectomy combined with stenting in high-risk patients with complex lesions achieved 100% procedural success and a 13.3% angiographic restenosis rate.
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