Hl. Dauerman et al., MECHANICAL DEBULKING VERSUS BALLOON ANGIOPLASTY FOR THE TREATMENT OF DIFFUSE IN-STENT RESTENOSIS, The American journal of cardiology, 82(3), 1998, pp. 277-284
Previous studies have shown a high rate of repeat intervention after t
reating diffuse in-stent restenosis with percutaneous transluminal cor
onary angioplasty (PTCA) alone. it is not clear whether debulking with
atherectomy is more effective in this condition, Between January 1994
and February 1997, we treated 60 consecutive patients with diffuse in
-stent restenosis of a native coronary artery using conventional PTCA
(n = 30) or debulking (with rotational or directional atherectomy) plu
s adjunctive PTCA (n 30). paired angiograms were analyzed by quantitat
ive angiography, and clinical follow-vp wets obtained in all patients
at 1 month, 6 months, and 1 year after revascularization. The mean les
ion lengths were 13.5 +/- 8.3 and 18.4 +/- 13.2 mm in the debulking an
d PTCA groups, respectively (p = 0.09). Acute procedural success was 1
00% in both cohorts, with no major complications in either group. Trea
tment with atherectomy plus adjunctive PTCA resulted in lower postproc
edure stenoses (18 +/- 10 vs 26 +/- 13%, p = 0.01) than treatment with
balloon angioplasty alone. At 1-year follow-up, repeat target vessel
revascularization wets required in 28% of patients in the debulking gr
oup compared with 46% in the PTCA group (p = 0.18). Independent predic
tors of the need for repeat target vessel revascularization were longe
r lesion lengths, diabetes mellitus, and smaller postprocedure lumen d
iameter. Thus, the strategy of atherectomy and adjunctive PTCA for dif
fuse in-stent restenosis is safe, improves acute angiographic results
compared with PTCA alone, and may decrease the need for target vessel
revascularization. (C)1998 by Excerpta Medica, Inc.