U. Dietz et al., HIGH-FREQUENCY ROTATIONAL ABLATION - AN ALTERNATIVE IN TREATING CORONARY-ARTERY STENOSES AND OCCLUSIONS, British Heart Journal, 70(4), 1993, pp. 327-336
Objective-To prove the safety and effectiveness of high frequency rota
tional ablation of coronary artery stenoses and occlusion in humans. S
ubjects-106 patients with symptoms (91 men, 15 women) who had 67 signi
ficant stenoses, mainly types B and C, and 46-chronic occlusions. Main
outcome measures-Mean change in diameter stenosis after rotational an
gioplasty alone and in combination with percutaneous transluminal coro
nary angioplasty immediately after treatment and 24 hours and six mont
hs later; restenosis rates at six months; complications of treatment.
Results-Rotational ablation could not be used in five stenoses and 16
chronic occlusions because of inability to reach or cross the lesion w
ith the Rotablator guide wire. In four cases rotational ablation faile
d. Initial angiographic and clinical success by rotational ablation wa
s achieved in 40 of the 67 stenoses (60%) and in 18 of the 46 chronic
occlusions (39%). Additional balloon angioplasty was performed in 45 p
atients, increasing the success rates to 79% and 54%, respectively. In
the 62 stenoses treated by rotational ablation the angiographic diame
ter stenoses were reduced from 76% (SD 14%) to 32% (14%) after Rotabla
tor treatment alone and from 75% (11%) to 33% (17%) with additional ba
lloon angioplasty. In the 30 chronic occlusions treated by rotational
ablation the angiographic diameter stenoses were reduced to 38% (18%).
At six months angiographic restenosis was evident in nine of the 25 (
36%) stenoses treated with rotational ablation alone, in seven of the
22 (32%) stenoses treated with rotational and balloon angioplasty, and
in 14 of the 24 (58%) chronic occlusions. There were no procedural de
aths and two patients (2%) underwent emergency coronary artery bypass
grafting. Although no transmural infarction occurred, there were five
(6%) non-Q wave infarctions (two embolic side branch occlusions, two s
ubacute occlusions, and one acute occlusion). Clinically insignificant
slight increases in creatine kinase activity were seen in five patien
ts (6%). Severe coronary artery spasm unresponsive to medical treatmen
t was provoked in seven cases (8%). Conclusions-High frequency rotatio
nal ablation is a safe and effective method for treating type B and C
coronary artery lesions with results comparable to percutaneous transl
uminal coronary balloon angioplasty. The combined use of rotational ab
lation and balloon angioplasty is feasible and is necessary in about h
alf of all procedures, in most cases because the lumen created by the
biggest burr is too small.