MECHANICAL DEBULKING VERSUS BALLOON ANGIOPLASTY FOR THE TREATMENT OF DIFFUSE IN-STENT RESTENOSIS

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.