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High‐speed rotational atherectomy and coronary stenting: QCA and QCU analysis
Author(s) -
Whitbourn Robert J.,
Sethi Rajiv,
Pomerantsev Eugene V.,
Fitzgerald Peter J.
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.10639
Subject(s) - medicine , stent , stenosis , cardiology , coronary angiography , nuclear medicine , atherectomy , coronary stenting , restenosis , radiology , myocardial infarction
To evaluate the acute effect of pretreatment with high‐speed rotational atherectomy (HSRA) on stent deployment (rotastenting), we studied 33 patients with rotastenting of 40 segments, 34 patients with 40 coronary segments treated with Palmaz‐Schatz stenting alone, and 34 patients with 40 segments treated with HSRA. The HSRA‐ and stent‐alone patient groups were selected retrospectively by matching the quantitative coronary angiography (QCA) reference diameter (D ref). QCA revealed similar baseline percent of stenosis (85.3% ± 12.4%), minimal luminal diameter (MLD), and D ref. The percent area expansion was calculated as a ratio between the minimal intrastent area and the reference area measured by intracoronary ultrasound. The rotastent group was characterized by more frequent calcification compared to HSRA and stent groups (67.5% vs. 20% and 12.5%; P < 0.01). Lesion length determined by QCA was longer both in the HSRA and the rotastent groups vs. the stent‐alone group (21.1 ± 12.3 and 20.9 ± 4.3 vs. 17.0 ± 7.7 mm; P < 0.05). In this small study, there was no difference demonstrated between final MLD in the rotastent and stent‐alone groups. However, a smaller MLD was achieved in the HSRA group (3.0 ± 0.7 vs. 3.1 ± 0.5 vs. 2.5 ± 0.7 mm, respectively; P < 0.01). The degree of stent expansion was higher in the rotastent group compared to the stent‐alone group (91.9% ± 4.4% vs. 79.7% ± 3.4%; P < 0.03) and the % residual area of plaque was less for the rotastent group than for the stent‐alone group (12.1% ± 13.2% vs. 21.1% ± 17.5%; P = 0.03). These data suggest that antecedent HSRA atheroma debulking using HSRA results in improved intravascular stent expansion and reduction in residual plaque, facilitating optimal stent deployment. Catheter Cardiovasc Interv 2003;60:167–171. © 2003 Wiley‐Liss, Inc.