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European Heart Journal 1992 13(7):918-924;
Copyright © 1992 by the European Society of Cardiology.
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© 1992 The European Society of Cardiology

One hundred and thirteen attempts at directional coronary atherectomy: the early and combined experience of two European centres using quantitative angiography to assess their results

V. UMANS*, E. HAINE{dagger}, J. RENKIN{dagger}, P. DE FEYTER*, W. WlJNS{dagger} and P. W. SERRUYS*,

*Catheterisation Laboratory, Thoraxcentre, University Hospital Dijkzigt, Erasmus University Rotterdam the Netherlands
{dagger}Division of cardiology, University of Louvain Medical School Bruxelles, Belgium

Received 1 July 1991; revised 7 November 1991; .

Correspondence. P. W. Scrruys, MD, PhD, Catheterisation Laboratory, Thoraxccnter, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, the Netherlands.

Abstract

Directional coronary atherectomy has been introduced as an alternative to conventional balloon angioplasty when treating coronary artery stenoses with complex lesion morphology. To determine the immediate efficacy of coronary atherectomy in patients with such lesions, the first 113 attempts at directional atherectomy in two centres using quantitative angiography were reviewed in 105 patients. The lesions were classified as complex stenosis since 95% had a symmetry index < 1.0, a length of 6.83±2.55mm on average and an area of plague of 9.77±6.69 mm2. Procedural success defined as a residual stenosis <50% after tissue retrieval was obtained in 90 (85.7%) of 105 patients. The primary angioplastic success rate, combining atherectomy and balloon angioplasty in case of failed attempt of atherectomy was 95.2%.

Coronary atherectomy was unsuccessful in five patients; three were referred for emergency coronary artery bypass grafting. Major complications (death, emergency surgery and transmural infarction) were encountered in 5.7% of the patients.

Assessed by quantitative coronary analysis, a residual minimal luminal diameter of 2.42±0.52 mm and a diameter stenosis of 26±12% were obtained immediately after directional coronary atherectomy. We conclude that directional coronary atherectomy is particularly suitable for the treatment of stenosis with complex lesion morphology and is associated with acceptable complication rates. Randomized trials comparing atherectomy with balloon angioplasty are warranted to clarify the role of atherectomy in the treatment of lesions in the proximal part of the three major epicardial coronary arteries.

Key Words: Coronary atherectomy • quantitative angiography


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