DIRECTIONAL CORONARY ATHERECTOMY (DCA) - INFLUENCE OF VESSEL SIZE ON PRIMARY AND LONG-TERM RESULTS

Of 325 consecutive patients undergoing DCA, 263 patients with 277 sten oses were successfully treated with DCA alone and had angiographic fol low-up 3-6 months later. Depending upon the initial reference diameter (RD) patients were divided into two subgroups: group I (n = 159) with a RD > 3 mm and group II (n = 104) showing a RD less than or equal to 3 mm. In contrast to other series DCA was predominantly performed wit h 7F atherectomy devices using balloon inflation pressures of approxim ately 5 atm. Angiographic data including the minimal luminal diameter (MLD), percentage of stenosis (%D) and reference diameter (RD) were as sessed by quantitative computer-assisted analysis before (pre), after (post) DCA and at a 3-6 months angiographic follow-up (FU). The percen tage of diameter stenosis pre/post/FU in group I was 59.9 +/- 12.6 %/1 8.4 +/- 12.8 %/29.8 +/- 17.6 %, and in group II 55.6 +/- 10.8 %/17.8 /- 12.3 %/33.7 +/- 16.1 % with a net gain at FU of 1.0 +/- 0.89 mm for group I and 0.86 +/- 0.66 mm for group II. Based on an angiographic r estenosis criterion of at least 50 % diameter obstruction at FU and or recurrence of symptoms warranting interventional re-treatment of the target lesion, the incidence of restenosis in group I was 20.6 % and i n group II 28.0% (p: n.s.). There was no significant difference betwee n the two groups concerning complications. Our data show that DCA lead s to a satisfying long-term result. Long-term results after DCA depend upon the MLD after DCA, the net gain at FU, the size of the atherecto my device, the balloon inflation pressure used as well as the RD of th e target vessel with better results in coronary arteries with a RD > 3 mm.