Advertisement

Impact of restenosis after optimal directional coronary atherectomy on regional left ventricular function

      This paper is only available as a PDF. To read, Please Download here.

      Abstract

      To assess the effect of optimal directional coronary atherectomy (DCA) on restenosis and left ventricular (LV) function, 95 patients who underwent DCA and adjunctive balloon angioplasty for de novo lesions were prospectively followed for 6 months. Absolute and relative coronary lumen measurements were analyzed with online quantitative coronary angiography. LV volumes, ejection fraction, and segmental wall motion were measured off-line according to the radial method for LV cineangiograms acquired in a right anterior oblique projection. Target vessels were the left anterior descending artery in 63 patients and right coronary artery in 32. Mean (± SD) reference diameter was 3.58 ± 0.65 mm. Mean lumen diameter improved significantly after DCA from 1.19 ± 0.44 to 3.03 ± 0.45 mm, yielding a 14 ± 10% residual stenosis. Overall angiographic restenosis rate (>50% stenosis in diameter) at control was 23%. In patients without restenosis, there were no significant changes in LV volumes or in LV pressures. In this subgroup, ejection fraction improved significantly in the left anterior descending group (mean difference 3 ± 10%, p < 0.04). Moreover, there was an increase in fractional shortening of all anterior segments (mean difference 11 ± 16%, p < 0.005). Improvement in fractional shortening was less marked in the right coronary artery group even without restenosis. We conclude that: (1) optimal DCA can achieve a low restenosis rate in selected large vessels, (2) long-term beneficial effects on regional LV function are possible, particularly in patients with left anterior descending disease and in the absence of coronary restenosis.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Hinohara T
        • Robertson GC
        • Selmon MR
        • Vetter JW
        • Rowe MH
        • Brader LJ
        • McAuley BJ
        • Sheehan DJ
        • Simpson JB
        Restenosis after directional coronary atherectomy.
        J Am Coll Cardiol. 1992; 20: 623-633
        • Fishman RF
        • Kuntz RE
        • Corrozza JP
        • Miller M
        • Senerchia CC
        • Schnitt SJ
        • Diver DJ
        • Safian RD
        • Baim DS
        Long-term results of directional atherectomy: predictors of restenosis.
        J Am Coll Cardiol. 1992; 20: 1101-1110
        • Umans VAWM
        • Robert A
        • Foley D
        • Wijns W
        • Haine E
        • de Feyter PJ
        • Serruys PW
        Clinical, histologic and quantitative angiographic predictors of restenosis after directional atherectomy: a multivariate analysis of the renarrowing process and late outcome.
        J Am Coll Cardiol. 1994; 23: 49-58
        • Topol EJ
        • Leya F
        • Pinkerton CA
        • Whitlow PL
        • Hofling B
        • Simonton C
        • Masden RR
        • Serruys PW
        • Leon M
        • Williams DO
        • King III, SB
        • Mark DB
        • Isner JM
        • Holmes DR
        • Ellis SG
        • Lee KL
        • Keeler GP
        • Hinohara T
        • Califf RM
        A comparison of directional coronary atherectomy with coronary angioplasty in patients with coronary artery disease.
        N Engl J Med. 1993; 329: 221-227
        • Adelman AG
        • Cohen EA
        • Kimball BP
        • Bonan R
        • Ricci DR
        • Webb JG
        • Laramee L
        • Barbeau G
        • Traboulsi M
        • Corbett BN
        • Schwartz L
        • Logan AG
        A comparison of directional coronary atherectomy with balloon angioplasty for lesions of the left anterior descending coronary artery.
        N Engl J Med. 1993; 329: 228-234
        • Simonton CA
        • Leon MB
        • Kuntz
        • Popma JJ
        • Hinohara T
        • Bersin RM
        • Yock PG
        • Wilson BH
        Acute and late clinical and angiographic results of directional atherectomy in the Optimal Atherectomy Study (OARS) (abstr).
        Circulation. 1996; 92: I-545
        • Wilson RF
        • Johnson MR
        • Marcus ML
        • Aylward PEG
        • Skorton DJ
        • Collins
        • White CW
        The effect of coronary angioplasty on coronary flow reserve.
        Circulation. 1988; 77: 873-885
        • Uren NG
        • Melin JA
        • De Bruyne B
        • Wijns W
        • Baudhuin T
        • Camici PG
        Relation between myocardial blood flow and the severity of coronary artery stenosis.
        N Engl J Med. 1994; 330: 1782-1788
        • Kuntz RE
        • Safian RD
        • Carrozza JP
        • Fisjman RF
        • Monsour M
        • Baim DS
        The importance of acute luminal diameter in determining restenosis after coronary atherectomy or stenting.
        Circulation. 1992; 86: 1827-1835
        • Braunwald E
        • Kloner RA
        The stunned myocardium: prolonged, postischemic ventricular dysfunction.
        Circulation. 1982; 66: 1146-1149
        • de Feyter PJ
        • Suryapranata H
        • Serruys PW
        • Beat K
        • van der Brabd M
        • Hugenholtz PG
        Effects of successful percutaneous transluminal coronary angioplasty on global and regional left ventricular function in unstable angina pectoris.
        Am J Cardiol. 1987; 60: 993-997
        • Colle JP
        • Legoff G
        • Carfora A
        • Delarche N
        • Kilpatrick DD
        • Besse P
        Longterm beneficial effects of PTCA on early segmentai relaxation in disease of the left anterior descending artery.
        Angiology. 1988; 39: 466-478
        • Reiber JHC
        • van der Zweet PMJ
        • von Land CD
        • Koning G
        • Loois G
        • Zorn I
        • van der Brand M
        • Gerbrands JJ
        On-line quantification of coronary angiograms with the DCI system.
        Medicamundi. 1989; 34: 89-98
        • Colle JP
        • Legoff G
        • Ohayon J
        • Bonnet J
        • Bricaud H
        • Besse P
        Quantitative frame by frame analysis of regional contraction and lengthening on left ventricular cineangiograms: application to the study of normal left ventricles and left ventricles with mitral valve prolapse.
        Clin Cardiol. 1986; 9: 43-51
        • Ingels NB
        • Daughters GT
        • Stinson EB
        • Alderman EL
        Evaluation of methods for quantitating left ventricular segmental wall motion in man using myocardial markers as a standard.
        Circulation. 1980; 61: 966-972
        • Umans VAWM
        • Keane D
        • Foley D
        • Boersma E
        • Melkert R
        • Serruys PW
        Optimal use of directional coronary atherectomy is required to ensure long-term angiographic benefit: a study with matched procedural outcome after atherectomy and angioplasty.
        J Am Coll Cardiol. 1994; 24: 1652-1659
        • Kuntz RE
        • Hinohara T
        • Robertson GC
        • Safian RD
        • Simpson JB
        • Baim DS
        Influence of vessel selection on the observed restenosis rate after endoluminal stenting or directional atherectomy.
        Am J Cardiol. 1992; 70: 1101-1108
        • Foley DP
        • Melkert R
        • Serruys PW
        Influence of coronary vessel size on renarrowing process and late angiographic outcome after successful balloon angioplasty.
        Circulation. 1994; 90: 1239-1251
        • Arbustini E
        • De Servi S
        • Bramucci E
        • Porcu E
        • Costante AM
        • Grasso M
        • Diegoli M
        • Fasani R
        • Morbini P
        • Angoli L
        • Boscarini M
        • Repetto S
        • Danzi G
        • Niccoli L
        • Campolo L
        • Lucreziotti S
        • Specchia G
        Comparison of coronary lesions obtained by directional coronary atherectomy in unstable angina, stable angina, and restenosis after either atherectomy or angioplasty.
        Am J Cardiol. 1995; 75: 675-682
        • Bauters C
        • Lablanche JM
        • MacFadden EP
        • Hamon M
        • Bertrand ME
        Relation of coronary angioscopic findings at coronary angioplasty to angiographic restenosis.
        Circulation. 1995; 92: 2473-2479
        • Baim DS
        • Kuntz R
        • Sharma SK
        • Fortuna R
        • Feldman R
        • Senerchia C
        • DeFeo T
        • Popma JJ
        • Ho KKL
        • The BOAT investigators
        Acute results of the randomized phase of the balloon versus optimal atherectomy trial (BOAT) (abstr).
        Circulation. 1995; 92: I-544
        • Vanoverschelde JLJ
        • Wijns W
        • Depré C
        • Essamri B
        • Heyndrickx GR
        • Borgers M
        • Bol A
        • Melin JA
        Mechanisms of chronic regional postischemic dysfunction in humans. New insights from the study of noninfarcted collateral-dependent myocardium.
        Circulation. 1993; 87: 1513-1523
        • Marwick TH
        • MacIntyre WJ
        • Lafont A
        • Nemec JJ
        • Salcedo EE
        Metabolic responses of hibernating and infarcted myocardium to revascularization. A follow-up study of regional perfusion, function, and metabolism.
        Circulation. 1992; 85: 1347-1353
        • Shen YT
        • Vatner SF
        Mechanism of impaired myocardial function during progressive coronary stenosis in conscious pigs. Hibernation versus stunning?.
        Circ Res. 1995; 76: 479-488
        • Nienaber CA
        • Brunken RC
        • Sherman CT
        • Yeatman LA
        • Gambhir SS
        • Krivokapich J
        • Demer LL
        • Ratib O
        • Child JS
        • Phelps ME
        • Schelbert HR
        Metabolic and functional recovery of ischemic human myocardium after angioplasty.
        J Am Coll Cardiol. 1991; 18: 966-978
        • Rosing DR
        • Cannon III, RO
        • Watson RM
        • Bonow RO
        • Mincemoyer R
        • Ewels C
        • Leon M
        • Lakatos E
        • Epstein SE
        • Kent KM
        Three-year anatomic, functional and clinical follow-up after successful percutaneous transluminal coronary angioplasty.
        J Am Coll Cardiol. 1987; 9: 1-7
        • van den Berg EK
        • Popma JJ
        • Dehmer GJ
        • Snow FR
        • Lewis SA
        • Vetrotec GW
        • Nixon JV
        Reversible segmental left ventricular dysfunction after coronary angioplasty.
        Circulation. 1990; 81: 1210-1216
        • Melgares R
        • Prieto JA
        • Azputarte J
        Significant coronary restenosis limits the recovery of regional left myocardial dysfunction achieved after successful coronary angioplasty.
        Eur Heart J. 1993; 14: 866-875
        • Galli M
        • Marcassa C
        • Bolli R
        • Giannuzzi P
        • Temporelli PL
        • Imparato A
        • Orrego S
        • Giubbini R
        • Giordano A
        • Tavazzi L
        Spontaneous delayed recovery of perfusion and contraction after the first 5 weeks after anterior myocardial infarction. Evidence for the presence of hibernating myocardium in the infarcted area.
        Circulation. 1994; 90: 1386-1397
        • Kugelmass AD
        • Cohen DJ
        • Moscucci M
        • Piana RN
        • Senerchia C
        • Kuntz RE
        • Baim DS
        Elevation of the creatine kinase myocardial isoform following otherwise successful directional coronary atherectomy and stenting.
        Am J Cardiol. 1994; 74: 748-754