EARLY EXPERIENCE OF DIRECTIONAL CORONARY ATHERECTOMY - CLINICAL-RESULTS, COMPLICATIONS AND HISTOPATHOLOGICAL FINDINGS

Objective: To report the early experience, clinical results and histop athologic findings of Directional Coronary Atherectomy from a UK centr e experienced in coronary angioplasty. Design: Prospective study of th e first 45 Directional Coronary Atherectomy (DCA) procedures using the Simpson coronary atherectomy device. Results: Forty-five procedures w ere performed in 33 male and 5 female patients (mean age, 55.1 years). Directional Coronary Atherectomy was performed to 50 lesions (39 de n ovo, 11 restenosis; 44 left anterior descending, 3 right, 2 circumflex coronary arteries and 1 saphenous vein graft). Clinical and primary a ngiographic success was achieved in 43 of 45 cases (95.5%) and in 47 o f 50 lesions (94%) after DCA alone. Before DCA the mean diameter steno sis was 88.7% (range, 50-100%) but following DCA (and percutaneous cor onary angioplasty (PTCA) if necessary) the mean diameter stenosis was 3.5% (range, 0-15%; P < 0.001). Complications included occlusive disse ction requiring coronary artery bypass surgery in two patients; abrupt closure of right coronary artery in one patient successfully reopened by PTCA and thrombolysis, complicated by excessive blood loss; revers ible coronary artery spasm due to minor nose-cone trauma in four patie nts and temporary side branch loss in one patient. There were no coron ary artery perforations, guide catheter complications, peripheral vasc ular trauma or deaths. On average 5.6 specimens (range, 1-18) were rem oved per case. Histology showed fibrous intimal plaque in 98%, media i n 39% and adventitia in 7%. Neo-intimal hyperplasia was found in all r estenosis lesions but also in 30% of de novo lesions. Conclusions: Thi s small initial series indicates that directional coronary atherectomy is an effective and safe procedure for the treatment of obstructive c oronary artery disease in carefully selected patients. With care, a hi gh success rate can be achieved even during a learning phase. The tech nique is particularly effective for morphologically complex lesions th at are unfavourable for PTCA. The procedure is unlike PTCA and require s additional training if pitfalls are to be avoided, high success rate s achieved and complication rates kept low.