Rotational atherectomy: Improved procedural outcome with evolution of technique and equipment. Single-center results of first 1,000 patients

We present our single-center experience of rotational atherectomy (RA) in t he first 1,000 consecutive patients divided arbitrarily into three differen t time periods corresponding to significant changes in technique or equipme nt for RA. Period I (August 1994 to April 1995; 172 cases) is characterized by early experience, longer ablation, and frequent use of intra-aortic bal loon pump; period II (May 1995 to January 1996; 254 cases) is characterized by short ablation runs (20-30 sec) and use of rotaflush; period III (Febru ary 1996 to February 1997; 574 cases) is characterized by ReoPro use, neosy nephrine boluses to avoid hypotension, and rota floppy wire and flexible sh aft burrs. The procedural success rate has improved and complication rates have progressively declined over these three time periods. The incidence of lesion complexity (long and type C lesions) and patients with unstable res t angina have increased over these time periods of PA. Therefore, modificat ion in procedural techniques and equipment over time have made RA a safe te chnique despite its use in Very complex lesion subsets. (C) 1999 Wiley-Liss , Inc.