DIRECTIONAL CORONARY ATHERECTOMY IN ACUTE MYOCARDIAL-INFARCTION

To date, application of directional coronary atherectomy (DCA) in acut e myocardial infarction (AMI) has had limited reports. In eleven patie nts with AMI, DCA was applied. In three of these patients, DCA was use d as a stand-alone procedure without use of thrombolytic agents. In ea ch case a guidewire was placed across the stenosis, and in eight patie nts balloon angioplasty was utilized as a predilating modality prior t o DCA. The thrombolytic agent urokinase was utilized in five of these eight patients, either before, during, or after angioplasty and/or DCA . DCA success (defined as ability to cross the lesion, reduction of le ss-than-or-equal-to 20% in stenosis and thrombolysis - when a thrombus is present) was achieved in 10 of 11 patients. One patient had persis tent abrupt reclosure of an LAD lesion, accompanied by hemodynamic com promise, necessitating intra-aortic balloon pump insertion and subsequ ent emergent coronary artery bypass graft surgery. Final angiograms re vealed residual stenoses less-than-or-equal-to 20%, and adequate throm bolysis. Significant cardiac events were limited to one emergent CABG, Q wave MI in four patients, and non-Q wave MI in two patients. Clinic ally all eleven patients improved, survived the AMI/CABG, and were dis charged. This clinical experience demonstrates the feasibility and saf ety of DCA application in selected patients who experience acute myoca rdial infarction.