DIRECTIONAL ATHERECTOMY OF AORTO-OSTIAL STENOSES

Balloon angioplasty of aorto-ostial right coronary artery (RCA) and ao rto-ostial saphenous vein graft (SVG) stenoses has been reported to be associated with a suboptimal acute success rate, a higher incidence o f restenosis and an increased risk of emergent coronary artery bypass surgery. In this report, we describe the use of directional coronary a therectomy (DCA) as a treatment alternative in a series of twenty thre e patients who were documented to have a > 60% stenosis within 3 mm of the origin of the RCA (15 patients) or SVG (8 patients) as measured b y on-line quantitative angiography. DCA was successfully performed in 14 of 15 RCA ostial lesions and in all eight SVG lesions. This yielded an acute success rate of 93% and 100% with a mean reduction in percen t stenosis from 87% to 9% and from 85% to 8% respectively. Only one pa tient, presenting with an ostial RCA lesion, was unable to be revascul arized using DCA. All successfully treated patients underwent exercise treadmill testing or repeat cardiac catheterization in follow-up. Cli nical evidence of restenosis defined as recurrent chest pain or ischem ic evidence on exercise treadmill and > 50% angiographic restenosis wa s demonstrated in three of twenty two patients (14%). Of the nine succ essfully treated patients who underwent repeat cardiac catheterization , three (33%) had restenosed for an angiographic rate of 25% for RCA a nd 50% for SVG lesions. In conclusion, DCA of aorto-ostial stenoses is technically feasible and can be performed with good initial results. It is associated with acceptably low rates of urgent aorto-coronary by pass surgery and clinical restenosis. DCA may yield results in these l esions superior to those obtained with balloon angioplasty.