Directional Intracoronary Atherectomy. In-Hospital and Follow-up Results

pp 129-136

Abstract

Background

Directional coronary atherectomy has shown good results in the treatment of complex lesions but its effect in restenosis has not yet been demonstrated.

Objective

To analize in-hospital and follow-up results of patients treated with directional coronary atherectomy.

Method

From August1992 to March 1995, 223 consecutive patients were treated with directional coronary atherectomy. The mean age was 57.5 years, 80.3% were male and 74.4% had unstable angina. In 76 patients (35.7%) the procedure was performed with IVUS guidance. All patients with procedural success (obstruction less than 50% without major complication) were eligible for follow-up. Major events were: death, myocardial infarction and the need of subsequent revascularization procedures (CABG or PTCA).

In-hospital results

The procedural success was 95.1%. The incidence of major complications was 4.9% (myocardial infarction 2.2%, CABG 2.7% and death 0.9%).Follow-up results A 93% follow-up for a mean period of 12.9 months was obtained. There were 2 deaths(1%),3 myocardial infarctions (1.5%),10.2% of the patient required CABG and 9.1% a new PTCA. At 33 months the actuarial survival free of myocardial infarction and reinterventions was 76 ± 3.4%. Event predictors were: treatment of multiple lesions (p < 0.007); bifurcation lesions (p < 0.03) and vessel size <_ 3.0 mm (p < 0.05).

Conclusions

1) Directional coronary atherectomy had a high procedural success with low complication rate. 2) At follow-up the incidence of major events and requirement of new interventions was low.