HIGH-FREQUENCY ROTATIONAL ABLATION - AN ALTERNATIVE IN TREATING CORONARY-ARTERY STENOSES AND OCCLUSIONS

Citation
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
Citations number
54
Categorie Soggetti
Cardiac & Cardiovascular System
Journal title
ISSN journal
00070769
Volume
70
Issue
4
Year of publication
1993
Pages
327 - 336
Database
ISI
SICI code
0007-0769(1993)70:4<327:HRA-AA>2.0.ZU;2-0
Abstract
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.