EFFECTS OF TECHNIQUE MODIFICATION ON IMMEDIATE RESULTS OF HIGH-SPEED ROTATIONAL ATHERECTOMY IN 710 PROCEDURES ON 656 PATIENTS

Seven hundred ten high speed rotational atherectomy (HSRA) procedures were performed in a single consecutive series of 656 patients. Stand a lone HSRA was performed in 253 patients (35%). HSRA with adjunctive lo w pressure (less than or equal to 2 ATM) balloon angioplasty (LP BA) w as performed in 221 patients (31%), and HSRA with adjunctive high pres sure (greater than or equal to 4 ATM) balloon angioplasty (HP BA) was performed in 236 patients (34%). Prognostically unfavorable Type B2 an d C lesions dominated the study group (74.7%). Procedural success rate was 96%. Emergency coronary artery bypass surgery was performed in 1. 4% of cases, Q wave myocardial infarction occurred in 3.4% and death, related to procedure, was consequent in 0.5% of cases. Incidence of fl ow limiting dissections was 3.1%, distal spasm was 5.3%, and ''no refl ow'' phenomenon was 1.8%. The recent technique modifications included continuous advancer/guiding catheter infusion of the nitroglycerin-ver apamil mixture, limitation of duration of lesion engagement by the bur r, stepwise increase in the burr size, decrease of rotational speed, a nd strict control of rpm drop during lesion ablation. Evolution of the interventional technique involved trends towards decrease of the use of HP BA in conjunction with steady increase in the percentage of SA a nd LP BA procedures over time. These technique changes resulted in com plete absence of ''no reflow'' in 1994, as well as a generalized decre ase in overall coronary vascular reactivity from all burr passes. (C) 1995 Wiley-Liss, Inc.