HIGH-FREQUENCY ROTATIONAL ABLATION FOLLOWING FAILED PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY

Percutaneous transluminal coronary angioplasty (PTCA) failed in 29 of 1,150 patients (2.5%) after successful passage of the guide wire. The reasons for failure were inability to pass the lesion with a balloon i n 28 patients and inability to dilate the lesion in 1 patient. In thes e patients (15 stenoses and 14 chronic occlusions) rotational ablation was performed. We were able to pass the burr through the lesion in al l of them, resulting in a reduction of diameter stenosis from 87 +/- 1 5 to 51 +/- 18%. Rotational ablation alone was initially successful (s tenoses reduction >20% and residual stenoses <50%) in 15 of 29 (52%) p atients. Additional PTCA was performed in 21 of 29 (72%) patients, in 8 to optimize the initially successful result and in 13 because the ou tcome was unsatisfactory. After dilatation the diameter stenosis was r educed to 41 +/- 14% immediately after the procedure and to 36 +/- 13% at 24 hr control. Overall success was achieved in 21 of 29 (72%) pati ents immediately after the procedure and in 26 of 29 (90%) patients at 24 hr control. No acute major complications occurred. We conclude tha t rotational ablation can be used as a safe and effective alternative when PTCA is not successful. (C) 1994 Wiley-Liss, Inc.