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Long‐term outcome of patients with proximal left anterior descending coronary artery in‐stent restenosis treated with rotational atherectomy
Author(s) -
Moreno Raúl,
García Eulogio,
Soriano Javier,
Acosta Julio,
Abeytua Manuel
Publication year - 2001
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.1098
Subject(s) - medicine , restenosis , myocardial infarction , cardiology , stent , revascularization , intravascular ultrasound , surgery , atherectomy , artery , radiology
Once a first interventional procedure has failed, patients with proximal left anterior descending in‐stent restenosis are frequently sent for surgical revascularization. Data on long‐term outcome in selected patients with proximal left anterior descending in‐stent restenosis treated with RA are lacking. The study's objective was to evaluate the long‐term outcome of patients with proximal left anterior descending artery in‐stent restenosis treated with rotational atherectomy. The study population is constituted by 42 patients with proximal left anterior descending in‐stent restenosis treated with rotational atherectomy. Patients were followed up for 2.1 ± 0.9 years (range, 6–54). Restenosis length was 16.5 ± 9.2 mm, and restenosis was diffuse (> 10 mm in length) in 30 (71.4%). The rotational atherectomy procedure was guided by intravascular ultrasound in 18 patients (42.9%). Maximum burr/artery ratio was > 0.7 in 24 (57.1%) patients. One patient suffered a periprocedural non–Q‐wave infarction, but no deaths, Q‐wave infarction, or new target vessel revascularization occurred during hospitalization. There were no deaths or myocardial infarctions after discharge. Sixteen patients (38.1%) needed a new revascularization, but only five (11.9%) underwent coronary bypass grafting at the end of the follow‐up (2.1 ± 0.9 years). The rate of surgical revascularization at 6 months, 1 year, and 3 years was 4.8%, 7.4%, and 18.4%, respectively. The rate of new target vessel revascularization at 6 months, 1 year, and 3 years was 16.7%, 36.5%, and 40.5%, respectively. Patients with ≤ 5 months since stent implantation had a significantly higher rate of new target vessel revascularization. Patients with proximal left anterior descending in‐stent restenosis may be safely treated with rotational atherectomy. This strategy is associated with a very good long‐term outcome, with few patients undergoing surgical revascularization. Cathet Cardiovasc Intervent 2001;52:435–442. © 2001 Wiley‐Liss, Inc.