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Coronary angioplasty and Rotablator atherectomy trial (CARAT): Immediate and late results of a prospective multicenter randomized trial
Author(s) -
Safian Robert D.,
Feldman Ted,
Muller David W.M.,
Mason Denise,
Schreiber Theodore,
Haik Bruce,
Mooney Michael,
O'Neill William W.
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.1151
Subject(s) - medicine , debulking , revascularization , atherectomy , angioplasty , lesion , surgery , lumen (anatomy) , restenosis , clinical endpoint , radiology , target lesion , percutaneous , coronary artery disease , randomized controlled trial , percutaneous coronary intervention , cardiology , stent , myocardial infarction , cancer , ovarian cancer
Mechanical rotational atherectomy with the Rotablator is widely used for percutaneous coronary revascularization, but the ideal debulking strategy remains unknown. The purpose of this study was to compare the immediate and late results after Rotablator using two treatment strategies: Large burrs (burr/artery ratio of >0.7) to achieve maximal debulking (lesion debulking strategy) or small burrs (burr/artery ratio ≤ 0.7) to modify lesion compliance (lesion modification strategy). Two hundred twenty‐two patients at six centers were prospectively enrolled in this study and randomly assigned to large (n = 104 patients with 118 lesions) or small (n = 118 patients with 136 lesions) burrs. The primary endpoint was final diameter stenosis at the end of the procedure, and secondary endpoints included inhospital angiographic and clinical complications, and target lesion revascularization at 6 months. Baseline demographic and angiographic characteristics were similar. There were no differences in procedural success, the extent of immediate lumen enlargement, inhospital ischemic complications, or late target vessel revascularization. However, compared with small burrs, patients randomized to large burrs were more likely to experience serious angiographic complications (5.1% vs. 12.7%, P < 0.05) immediately after atherectomy. This study suggests that a routine lesion modification strategy employing small burrs (burr/artery ratio ≤ 0.7) achieves similar immediate lumen enlargement and late target vessel revascularization compared with a more aggressive debulking strategy (burr/artery ratio >0.7), but with fewer angiographic complications. Cathet Cardiovasc Intervent 2001;53:213–220. © 2001 Wiley‐Liss, Inc.