SIDE-BRANCH OCCLUSION WITH DIRECTIONAL CORONARY ATHERECTOMY - INCIDENCE AND RISK-FACTORS

Side-branch occlusion is a recognized complication of directional coro nary atherectomy (DCA). To evaluate the incidence, risk factors, and c linical outcome of side-branch compromise, we analyzed our first 100 c onsecutive atherectomies of native coronary arteries. Seventy-eight pa tients had 122 side branches at risk, 21 (17%) of which demonstrated c ompromised flow after DCA. Origin of the side branch from the culprit atheroma and preexisting side-branch ostial stenosis were highly predi ctive of this complication in 20 of 55 (p < 0.05) and 14 of 31 (p < 0. 05) lesions, respectively. There was one non-Q-wave myocardial infarct ion, no emergency surgeries, and no deaths. In conclusion, side-branch loss after DCA occurs with a frequency similar to balloon angioplasty and was well tolerated in our patient population. Side branches that originate directly from culprit lesions or that have significant ostia l narrowing have a higher incidence of this complication.