High speed rotational coronary atherectomy for patients with diffuse coronary artery disease

AbstractHigh speed rotational coronary atherectomy was undertaken using the Rotabiator in 42 patients who were suboptimal candidates for balloon angioplasty. Most patients (71%) had diffuse coronary artery disease, defined as a stenosis >1 cm in length. Previous restenosis after balloon angioplasty was present in 21% and 10% had an ostial lesicn. Adjunctive balloon angioplasty was not used to reduce residual stenosis after atherectomy.The procedure was successful in 76% of patients. Procedural success was achieved in 92% of patients with a lesion ≤1 cm in length, but in only 70% of patients with a lesion >1 cm in length (p < 0.01). One patient sustained abrupt closure of the target vessel, resulting in emergency bypass surgery and death. Small non-Q wave myocardial infarction occurred in eight patients (19%) and was associated with a longer lesion. The mean peak creatine kinase value in patients with non-Q wave myocardial infarction was 683 U/liter. Transient regional wall motion abnormalities were noted on the postatherectomy left ventricular angiogram in four of the eight patients with non-Q wave myocardial infarction.Follow-up angiography (at a mean interval of 6.2 ± 2.6 months) was performed in 91% of patients and revealed restenosis (>58% narrowing) in 59%. The restenosis rate was 22% for short lesions (≤ cm) and 75% for long lesions (>1 cm) (p < 0.05).In this study, the results of high speed rotational coronary atherectomy were strongly influenced by lesion length. Although short lesions (≤ cm) were treated effectively, longer lesions (>1 cm) were associated with decreased procedural success, increased procedural complications and a higher restenosis rate