DIRECTIONAL CORONARY ATHERECTOMY FOR LESIONS OF THE PROXIMAL LEFT ANTERIOR DESCENDING ARTERY - INITIAL CLINICAL-RESULTS, COMPLICATIONS AND HISTOPATHOLOGICAL FINDINGS

Background: Directional coronary atherectomy is a percutaneous techniq ue which extends the role of balloon angioplasty to bulky eccentric co ronary lesions. Aims: To report the early experience, clinical results , complications and histopathological findings of directional coronary atherectomy (DCA) in proximal left anterior descending artery (LAD) s tenosis. Methods: Study of 25 lesions in 24 patients on whom direction al atherectomy was performed on the proximal LAD artery with the Simps on coronary atherectomy device. Results: Twenty-five procedures were p erformed on 24 patients with stenosis in the proximal LAD artery. Ther e were 21 males and three females with a mean age of 56.5 years. Sixte en patients presented with stable angina and eight with unstable angin a. Eight patients had previous myocardial infarction (MI). Angiographi c success was obtained in 24 of 25 lesions (96%). The mean lesion leng th was 13.1 +/- 3.7 mm and the mean LAD artery diameter was 3.6 +/- 0. 5 mm. Minimal luminal diameter improved from 0.9 +/- 0.4 mm to 3.0 +/- 0.5 mm and the percentage diameter stenosis reduced from 75 +/- 12% t o 16 +/- 9%. Complications included acute occlusion in one patient, no n-Q MI in three patients, local vascular complications in one patient and side-branch loss in one patient. Histology demonstrated fibrous ca p of atherosclerotic plaque in 100%, media and internal elastic lamina in 28% and intimal hyperplasia in 100% of restenotic lesions and 27% of native lesions. Restenosis rates in angiographically restudied pati ents was 27%. The mean minimal luminal diameter at followup was 2.3 +/ - 0.9 mm and the mean percentage diameter stenosis was 35 +/- 21%. Con clusion: From this initial study, we conclude that DCA is an effective and safe procedure for the treatment of large proximal LAD lesions. D CA provides a large luminal diameter and a 'smoother' angiographic app earance compared to coronary angioplasty. Acute complication rates are low and restenosis rates were comparable with percutaneous translumin al coronary balloon angioplasty.