OUTCOME OF NARROWING RELATED SIDE BRANCHES AFTER HIGH-SPEED ROTATIONAL ATHERECTOMY

High-speed rotational atherectomy (HSRA) is advocated for calcified an d diffusely narrowed coronary arteries. There are often side branches involving these kinds of lesions. The presence of significant lesion-r elated side branches has been considered a relative contraindication t o rotational atherectomy. This study was performed to determine the ra te, predictors, and outcome of side branch occlusion after HSRA. The a ngiograms of 418 patients were examined with 320 side branches in 240 target vessels of greater than or equal to 1 mm in diameter being iden tified. Vessels were scored as either perfused (Thrombolysis In Myocar dial Infarction grade 2 or 3 flow) or occluded (Thrombolysis In Myocar dial Infarction 0 or 1 flow) before and after the procedure. A detaile d quantitative angiographic analysis was performed on a total of 108 s ide branches including all cases of branch occlusion. Clinical outcome s were determined in all cases with side branch loss. There were 24 oc clusions in 21 patients after the procedure, giving a rate of branch l oss of 7.5%. Fellow-up angiography at greater than or equal to 24 hour s was available for 13 of the occluded branches and 12 were found to b e patent. In the 21 patients with branch occlusion, 6 sustained a myoc ardial infarct (of which 5 were non-Q-wave), 2 underwent coronary arte ry bypass grafting, and 2 died. There are frequently lesion-associated side branches in the types of vessels to undergo HSRA. These branches remained patent 92.5% of the time, withocclusion occurring infrequent ly and usually being transient. When occlusion did occur, there was a 29% incidence of myocardial infarction.