OPTIMAL BURR AND ADJUNCTIVE BALLOON SIZING REDUCES THE NEED FOR TARGET ARTERY REVASCULARIZATION AFTER CORONARY MECHANICAL ROTATIONAL ATHERECTOMY

We analyzed the effect of differing burr and balloon sizes during mech anical rotational atherectomy on the need for target vessel revascular ization at 6 months. The ideal burr/artery ratio and adjunctive balloo n/artery ratio for optimizing acute luminal results and minimizing res tenosis is unknown. Six-month clinical follow-vp was obtained in 311 p atients (339 lesions) treated with rotational atherectomy from August 1993 to September 1994, to determine whether procedural results or tec hnique were related to the need for target vessel revascularization. T arget vessel revascularization, defined as repeat percutaneous interve ntion or bypass surgery within 6 months after rotational atherectomy, occurred in 19% of patients. Larger burr/artery ratios, defined as the final burr size divided by the reference artery size, were correlated with decreased postatherectomy diameter stenosis (p <0.009) and decre ased final diameter stenosis (p <0.03). However, there was no statisti cal association between postatherectomy or final diameter stenosis wit h need for revascularization (p=not significant [NS]). The need for re vascularization was lowest for burr/artery ratio between 0.6 to 0.85 ( 15%) versus burr/artery (0.6 or >0.85 (25%) (p <0.04). Postatherectomy , smaller balloon/artery ratios, defined as the final balloon size div ided by the reference artery size, were correlated with lower repeat r evascularization sates. Balloon/artery ratios <0.95 (target vessel rev ascularization=11% vs 25% in balloon/artery >0.95) were associated wit h the best luminal results and the least risk for clinical restenosis (p <0.006). Far rotational atherectomy, despite improvement in acute l uminal results with increased burr/artery ratio, the use of a moderate burr/artery ratio correlated with the lowest revascularization rates. There was no correlation between postatherectomy or final diameter st enosis and need for repeat interventions. However, the use of large ba lloon/artery ratios after rotablator was associated with higher target vessel revascularization rates. (C) 1996 by Excerpta Medica, Inc.