RESTENOSIS FOLLOWING SUCCESSFUL ROTATIONAL ABLATION OF DE-NOVO CORONARY STENOSES

Purpose: To evaluate the effects of rotational ablation on restenosis as well as to study the relationship of variables which may modulate r estenosis. Background: Previous reports have speculated that during at herectomy the extent of tissue debulking may effect restenosis. This i s felt to reflect an interplay between lumen size and wound healing ch aracteristics. We therefore applied the Percent Area Burr/Lumen Relati onship (PABLR), a simple approximation of tissue debulking, and analyz ed the effect of this calculation on restenosis. Data: 111 patients wi th 156 denovo stenosis underwent rotational ablation. 9.6% were AHA/AC C Type A, 62.8% were Type B and 27.6% were Type C lesions. Procedural success was achieved in 95.5%, 3.2% were unsuccessful/uncomplicated, a nd 1.3% had a major cardiac event. 25% were standalone procedures and 75% underwent complementary balloon angioplasty. At followup (12.5 +/- 4 months), 97/104 (93.4%) were alive and free of myocardial infarctio n. The overall clinical and angiographic restenosis rate was 33.3% per patient, and 30.2% per lesion. When correlated with tissue debulking, the restenosis rate was significantly lower (p<.05) when greater than 40, but less than 100% of the PABLR was achieved. Using a logistic re gression model, PABLR was the only clinical, morphologic, or procedura l factor significantly associated with restenosis. Conclusion: This in formation suggests an independent and beneficial effect of tissue debu lking on the rate of restenosis provided that a close approximation be tween burr and angiographic lumen size is maintained..