Clinical and angiographic predictors of recurrent restenosis after percutaneous transluminal rotational atherectomy for treatment of diffuse in-stentrestenosis

Due to the widespread use of stents in complex coronary lesions, stent rest enosis represents an increasing problem, for which optimal treatment is und er debate. "Debulking" of in-scent neointimal tissue using percutaneous tra nsluminal rotational atherectomy (PTRA) offers an alternative approach to t issue compression and extrusion achieved by balloon angioplasty. One hundre d patients (70 men, aged 58 +/- 11 years) with a first in-stent restenosis underwent PTRA using an incremental burr size approach followed by adjuncti ve angioplasty. The overage lesion length by quantitative angiography was 2 1 +/- 8 mm (range 5 to 68) including 22 patients with a length greater than or equal to 40 mm. Twenty-nine patients had complete stent occlusions with a lesion length of 44 +/- 23 mm. Baseline diameter stenosis measured 78 +/ - 17%, was reduced to 32 +/- 9% after PTRA, and further reduced to 21 +/- 1 0% after adjunctive angioplasty. Primary PTRA was successful in 97 of 100 p atients. Clinical success was 97%, whereas 2 patients developed non-Q-wave infarctions without clinical sequelae. Clinical follow-vp was available for all patients at 5 +/- 4 months without any cardiac event. Angiography in 7 2 patients revealed restenosis in 49%, with necessary target lesion reinter vention in 35%. The incidence of rerestenosis correlated with the length of the primarily stented segment and the length of a first in-stent restenosi s. Thus, PTRA offers an alternative approach to treat diffuse in-stent rest enosis. Neointimal debulking of stenosed stents can be achieved effectively and safely, PTRA resulted in an acceptable recurrent restenosis rate in sh ort and modestly diffuse lesion, whereas the restenosis rate in very long l esions remains high despite debulking. (C) 1999 by Excerpta Medico, Inc.