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Clinical Trial
Journal Article
Rotational coronary atherectomy with adjunctive balloon angioplasty for the treatment of ostial lesions.
Catheterization and Cardiovascular Diagnosis 1994 September
Conventional balloon angioplasty (PTCA) of ostial lesions (OL) is associated with suboptimal results and a higher complication rate. Partial plaque ablation with rotational atherectomy (RA) before PTCA might improve results. This approach was used in 63 patients (pts) (mean age 64 +/- 10 yrs; 44 men, 19 women) with 69 OL. There were 15 aorto-OL and 54 branch-OL. Calcification was more frequent in aorto-OL than in branch-OL (67% vs. 35%, P < 0.05). Mean burr size was 1.8 +/- 0.3 mm. Burr-artery ratio was 0.74 +/- 0.10. Adjunctive PTCA was systematically performed. Procedural success was achieved in 58 pts (92%): 14 aorto-OL (93%) and 50 branch-OL (93%) were successfully treated; major complications occurred in 1 (7%) aorto-OL and 1 (2%) branch-OL. Uncomplicated failure occurred in three cases. Minimal lumen diameter (MLD) increased from 0.69 +/- 0.31 mm before RA to 1.43 +/- 0.28 mm after RA (P < 0.001) and 2.16 +/- 0.29 mm after PTCA (P < 0.001). Diameter stenosis (DS) decreased from 75 +/- 13% before RA to 32 +/- 12% after RA (P < 0.001) and 14 +/- 10% after PTCA (P < 0.001). All successfully treated pts underwent repeat angiography 24 h later and exercise testing or repeat cardiac catheterization > 6 mo later. At 24 h repeat angiography, DS was 17 +/- 15% (P = NS vs. after PTCA); no lesion had a DS > or = 50%. Follow-up coronary angiography was performed in 30 pts (52%) who had abnormal stress testing: 13 pts (43%) showed angiographic restenosis in at least one successfully treated OL. (ABSTRACT TRUNCATED AT 250 WORDS)
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