Directional Coronary atherectomy for the treatment of Palmaz-Schatz in-stent restenosis

Management of in-stent restenosis has become a significant challenge in int erventional cardiology. The results of balloon angioplasty have been disapp ointing due to the high recurrence of restenosis at follow-vp. Debulking of the restenotic tissue within the stents using directional coronary atherec tomy (DCA) may offer a therapeutic advantage. We report the immediate clini cal and angiographic outcomes and long-term clinical follow-up results of 4 5 patients (46 lesions), mean age 63 +/- 12 years, 73% men, with ct mean re ference diameter of 2.9 +/- 0.6 mm, treated with DCA for symptomatic Palmaz -Schatz in-stent restenosis. DCA was performed successfully in all 46 lesio ns and resulted In a postprocedural minimal luminal diameter of 2.7 +/- 0.7 mm and a residual diameter stenosis of 17 +/- 10%. There were no in-hospit al deaths, Q-wave myocardial infarctions, or emergency coronary artery bypa ss surgeries. Four patients (9%) suffered a non-Q-wave myocardial infarctio n. Target lesion revascularization was 28.3% at a mean follow-vp of 10 +/- 4.6 months. Kaplan-Meier event-free survival (freedom from death, myocardia l infarction, and repeat target lesion revascularization) was 71.2% and 64. 7% at 6 and 12 months after DCA, respectively. Thus, DCA is safe and effica cious for the treatment of Palmaz-Schatz in-stent restenosis. It results in a large postprocedural minimal luminal diameter and a low rate of both tar get lesion revascularization and combined major clinical evens at follow-vp . (C) 1998 by Excerpta Medica, Inc.