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Directional coronary atherectomy vs. rotational atherectomy for the treatment of in‐stent restenosis of native coronary arteries
Author(s) -
Sanchez Pedro L.,
RodriguezAlemparte Maximo,
ColonHernandez Pedro J.,
Pomerantsev Eugene,
Inglessis Ignacio,
Mahdi Nasser A.,
Leinbach Robert C.,
Palacios Igor F.
Publication year - 2003
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.10399
Subject(s) - medicine , restenosis , mace , atherectomy , cardiology , stent , debulking , coronary arteries , angioplasty , lesion , artery , revascularization , intimal hyperplasia , myocardial infarction , radiology , surgery , percutaneous coronary intervention , ovarian cancer , cancer , smooth muscle
Management of in‐stent restenosis has become a significant challenge in interventional cardiology. Since the mechanism of in‐stent restenosis is predominantly intimal hyperplasia, debulking techniques have been used to treat this condition. This study is a nonrandomized comparison of the immediate and long‐term results of directional coronary atherectomy (DCA; n = 58) vs. high‐speed rotational atherectomy (ROTA; n = 61) for the treatment of in‐stent restenosis of native coronary arteries. There were no in‐hospital deaths, Q‐wave myocardial infarctions, or emergency coronary artery bypass surgery in either group. DCA resulted in a larger postprocedural minimal luminal diameter of (2.57 ± 0.51 vs. 2.14 ± 0.37 mm; P < 0.0001) and a larger acute gain (1.83 ± 0.52 vs. 1.42 ± 0.48 mm; P < 0.0001). Furthermore, 12‐month clinically indicated target lesion revascularization (39% vs. 21%; P = 0.02) and long‐term follow‐up MACE (44% vs. 28%; P = 0.03) was greater in the ROTA group. The present study suggests that DCA appears to be superior to ROTA for the treatment of in‐stent restenosis of native coronary arteries. Compared to ROTA, the debulking effect of DCA leads to a larger postprocedure minimal luminal diameter, and a lower incidence of subsequent target lesion revascularization and MACE. Cathet Cardiovasc Intervent 2003;58:155–161. © 2003 Wiley‐Liss, Inc.