MULTI-INSTRUMENTAL REVASCULARIZATION ADJU STED TO THE CORONARY LESIONS (MIRACLE) - THE ROLE OF NEW TECHNOLOGIES

Several new techniques have been developed to get round the limitation s of conventional coronary angioplasty. Most entail ablation of the at heromatous plaques by mechanical (atherectomy) or photochemical (laser excimer) means, whilst others (stents) shore up the vascular walls. T heir use with conventional coronary balloon angioplasty optimises the results of treatment of complex lesions. This report describes the aut hors' experience in 1 266 patients (1 668 lesions) treated between Jan uary 1992 to December 1993. The new techniques were used in 33% of pat ients and 30% of lesions (rotational) atherectomy: 20%; stents : 5%; d irectional atherectomy: 3%; laser excimer : 2%) because of the defavou rable angiographic characteristics of the lesions (eccentricity, calci fication, bifurcation, length, chronic total occlusion, thrombosis, os tial stenosis, ulceration, saphenous vein graft). The primary success rate was 91% in the whole group (94 to 97% for the patients treated by the new techniques). The global major complication rate was 1.7%. The multi-instrumental revascularization adjusted to the coronary lesions (MIRACLE) gives a high primary success rate in patients with coronary lesions difficult to treat by conventional angioplasty. Randomised tr ials will be necessary to determine the precise indications of each te chnique with respect to the morphological characteristics of each lesi on.