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Long-term clinical follow-up after directional coronary atherectomy

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      Abstract

      Although several studies have been done to assess the safety, efficacy, and angiographic restenosis rates of directional coronary atherectomy (DCA), there have been no studies to document the need for repeat revascularization of the target vessel based purely on recurrence of symptoms. To answer this question, clinical and angiographic data were obtained for 187 consecutive patients undergoing this procedure on a native coronary artery utilizing a lesion specific approach in a referral hospital. Most of the patients had anginal symptoms that were not well controlled with medical therapy. The decision to perform DCA was based on the lesion characteristics (i.e., eccentric, ulcerated, or irregular discrete lesions in a large epicardial vessel). The procedure was successful in 96% of patients. In-hospital major complications were seen in 6 patients (3%) including acute myocardial infarction in 3 (1.5%) and emergency coronary artery bypass surgery in the other 3 (1.5%). There were no deaths. Among 141 consecutive successful patients on whom the procedure was performed between January 1992 and June 1994, 128 (91%) were contacted. At 6 months, revascularization was required in 20 patients for recurrent anginal symptoms, and there were no deaths or myocardial infarctions. The clinical restenosis rate, therefore, was 15.6%. At long-term follow-up (25 ± 9 months), revascularization was performed in 3 more patients. One patient had a myocardial infarction and 3 patients died of noncardiac causes. Among those without clinical restenosis, 83% patients were asymptomatic and the rest had infrequent chest pains effectively managed with medications. The patients in the study group were using an average of 1.2 cardiac medications. Quality of life improved in 74% of the patients. Thus, in this study utilizing a lesion specific approach, the success rate for DCA was comparable to the published trials and in-hospital complications were few. The long-term clinical outcome was favorable with a low rate of clinical restenosis requiring repeat revascularization.
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      References

        • Baim DS
        • Hinohara T
        • Holmes D
        • Topol E
        • Pinkerton C
        • King III, SB
        • Whitlow P
        • Kereiakes D
        • Farley B
        • Simpson JB
        • The US Directional Coronary Atherectomy Investigator Group
        Results of directional coronary atherectomy during multicenter preapproval testing.
        Am J Cardiol. 1993; 72: 6E-11E
        • Hinohara T
        • Robertson GC
        • Selmon MR
        • Vetter JW
        • McAuley BJ
        • Sheehan DJ
        • Simpson JB
        Directional coronary atherectomy complications and management.
        Cathet Cardiovasc Diag. 1993; 28–29: 61-71
        • Potkin BN
        • Mintz GS
        • Pichard AD
        • Satler LF
        • Leon MB
        • Keller MB
        • Ewels CJ
        • Kent KM
        Late, out-of-laboratory, abrupt closure after angiographically successful directional coronary atherectomy.
        Am J Cardiol. 1992; 69: 263-272
        • Safian RD
        • Gelbfish JS
        • Erny RE
        • Schnitt SJ
        • Schmidt DA
        • Baim DS
        Coronary atherectomy: clinical, angiographic, and histologic findings and observations regarding potential mechanisms.
        Circulation. 1990; 82: 69-79
        • Ellis SG
        • DeCesare NB
        • Pinkerton CA
        • Whitlow P
        • King SB
        • Ghazzal ZMB
        • Kereiakes DJ
        • Popma JJ
        • Menke KK
        • Topol EJ
        • Holmes DR
        Relation of stenosis morphology and clinical presentation to the procedural results of directional coronary atherectomy.
        Circulation. 1991; 84: 644-653
        • Hinohara T
        • Rowe MH
        • Robertson GC
        • Selmon MR
        • Braden L
        • Leggett JH
        • Vetter JW
        • Simpson JB
        Effect of lesion characteristics on outcome of directional coronary atherectomy.
        J Am Coll Cardiol. 1991; 17: 1112-1120
        • Fishman RF
        • Kuntz RE
        • Carrozza JP
        • Miller MJ
        • Senerchia CC
        • Schnitt SJ
        • Diver DJ
        • Safian RD
        • Baim DS
        Long-term results of directional coronary atherectomy; predictors of restenosis.
        J Am Coll Cardiol. 1992; 20: 1101-1110
        • Popma JJ
        • De Cesare NB
        • Pinkerton CA
        • Kereiakes DJ
        • Whitlow P
        • King III, SB
        • Topol EJ
        • Holmes DR
        • Leon MB
        • Ellis SG
        Quantitative analysis of factors influencing late lumen loss and restenosis after directional coronary atherectomy.
        Am J Cardiol. 1993; 71: 552-557
        • Kuntz Re
        • Hinohara T
        • Safian RD
        • Selmon MR
        • Simpson JB
        • Baim DS
        Restenosis after directional coronary atherectomy: the effects of luminal diameter and deep wall excision.
        Circulation. 1992; 86: 1394-1399
        • Hinohara T
        • Robertson GC
        • Selman MR
        • Vetter JW
        • Rowe MH
        • Braden LJ
        • McAuley BJ
        • Sheehan DJ
        • Simpson JB
        Restenosis after directional coronary atherectomy.
        J Am Coll Cardiol. 1992; 20: 623-632
        • Kuntz RE
        • Safian RD
        • Levine MJ
        • Reis GJ
        • Diver DJ
        • Baim DS
        Novel approach to the analysis of restenosis after the use of three new coronary devices.
        J Am Coll Cardiol. 1992; 19: 1493-1499
        • Topol EJ
        • Leya F
        • Pinkerton CA
        • Whitlow PL
        • Hofling B
        • The CAVEA study group
        A comparison of directional atherectomy with coronary angioplasty in patients with coronary artery disease.
        N Engl J Med. 1993; 329: 221-227
        • Elliot JM
        • Berdan LG
        • Holmes DR
        • Isner JM
        • King SB
        • The CAVEAT study investigators
        One-year follow-up in the coronary angioplasty versus excisional atherectomy trial (CAVEAT I).
        Circulation. 1995; 91: 2158-2166
        • 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 atherectomy with balloon angioplasty for lesions of the left anterior descending coronary artery.
        N Engl J Med. 1993; 329: 228-233
        • Ellis SG
        • Holmes DR
        Strategic approaches in coronary intervention.
        in: Hinohara T Directional Coronary Atherectomy: Current Prospects. Williams & Wilkins, Baltimore1996: 3-16
        • Hinohara T
        • Robertson GC
        • Selmon MR
        • Vetter JW
        • Rowe MH
        • Braden LJ
        • McAuley BJ
        • Sheehan DJ
        • Simpson JB
        Restenosis after directional coronary atherectomy.
        J Am Coll Cardiol. 1992; 20: 623-632
        • Garratt KN
        • Holmes Jr, DR
        • Bell MR
        • Berger PB
        • Kaufmann UP
        • Bresnahan JF
        • Vlietstra RE
        Results of directional atherectomy of primary atheromatous and restenotic lesions in coronary artery and saphenous vein grafts.
        Am J Cardiol. 1992; 70: 449-454
        • Mehta VY
        • Jorgensen MB
        • Raizner AE
        • Wolde-Tsadik G
        • Mahrer PR
        • Mansukhani P
        Spontaneous regression of restenosis: an angiographic study.
        J Am Coll Cardiol. 1995; 26: 696-702
        • Fischman DL
        • Leon MB
        • Baim D
        • Schatz RA
        • Savage MP
        • Penn I
        • Detre K
        • Veltri L
        • Ricci D
        • The Stent Restenosis Study Investigators
        A randomized comparison of coronary stent placement and balloon angioplasty in the treatment of coronary artery disease.
        N Engl J Med. 1994; 331: 496-501
        • Serruys PW
        • De Jaegere P
        • Kiemeneij F
        • Macaya C
        • Rutsch W
        • Heynrickx G
        • Emanuelsson H
        • Marco J
        • The Benestent Study Group
        A comparison of balloon expandable stent implantation with balloon angioplasty in patients with coronary artery disease.
        N Engl J Med. 1994; 331: 489-495
        • 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
        • Schomig A
        • Neumann F
        • Kastrati A
        • Schulhen H
        • Blasini R
        • Hadamitzky M
        • Walter H
        • Zitzmann-Roth EZ
        • Richardt G
        • Alt E
        • Schmitt C
        • Ulm K
        A randomized comparison of antiplatelet and anticoagulant therapy after the placement of coronary artery stents.
        N Engl J Med. 1996; 334: 1084-1089
        • Hass WK
        • Easton JD
        • Adams Jr, HP
        • Pryse-Phillips W
        • Molony BA
        • Anderson S
        • Kamm B
        A randomized trial comparing ticlopidine hydrochloride with aspirin for the prevention of stroke in high risk patients.
        N Engl J Med. 1989; 321: 501-507
        • Gent M
        • Blakely JA
        • Easton JD
        • Ellis DJ
        • Hachinski VC
        • Harbison JW
        • Panak E
        • Roberts RS
        • Sicurella J
        • Turpie AG
        The Canadian American Ticlopidine Study (CATS) in thromboembolic stroke.
        Lancet. 1989; 1: 1215-1220