February 3, 1998Open Access
View Full Paper‘Optimal’ Directional Coronary Atherectomy
Structured PICO
Does optimal directional coronary atherectomy improve angiographic restenosis and clinical outcomes in patients with coronary lesions?
P
Population
199 consecutive patients with 213 de novo or restenotic lesions in 3.0- to 4.5-mm native coronary arteries
I
Intervention
Optimal directional coronary atherectomy (DCA) using a 7F atherectomy device and adjunctive balloon angioplasty (PTCA) if necessary to achieve a < 15% residual stenosis
O
Outcome
6-month angiographic restenosis rate and 1-year clinical outcomes (including target lesion revascularization and death)surrogate
Optimal directional coronary atherectomy achieved low residual stenosis and acceptable 6-month restenosis rates without increasing early or late major adverse events.
Abstract
BACKGROUND: Previous clinical trials of directional coronary atherectomy (DCA) have failed to show significant improvement in early or late outcomes compared with balloon angioplasty (PTCA). The present study tested the hypothesis that more aggressive "optimal" atherectomy could be performed safely to produce larger initial lumen diameters and a lower late restenosis rate. METHODS AND RESULTS: The present study was a prospective multicenter registry of consecutive patients undergoing optimal DCA of de novo or restenotic lesions in 3.0- to 4.5-mm native coronary arteries. Optimal DCA was defined as using a 7F atherectomy device and adjunctive PTCA if necessary to achieve a 3 times normal) occurred in 14% of patients. Mean reference vessel diameter was 3.28 mm. Mean diameter stenosis was reduced from 63.5% to a final stenosis of 7%. Late 1-year clinical follow-up revealed one cardiac death and a target lesion revascularization rate of 17.8%. The angiographic restenosis rate at 6 months was 28.9%, with the major predictor of restenosis being a smaller postprocedure lumen diameter. CONCLUSIONS: Optimal DCA produced a low residual percent diameter stenosis and a lower restenosis rate than seen in previous trials without an increase in early or late major adverse events.