ACUTE DIRECTIONAL CORONARY ATHERECTOMY PRIOR TO STENTING IN COMPLEX CORONARY LESIONS - ADAPTS STUDY

The purpose of this study was to determine the results of directional coronary atherectomy (DCA) combined with stenting in a high-risk patie nt population. The use of stenting or DCA alone for aorto-ostial lesio ns, total chronic occlusions, long lesions, and lesions containing thr ombus is associated with lowered success and a relatively high resteno sis rate. Between July 1993 and October 1996, we treated 89 lesions wi th the combined approach of DCA and stenting in 60 consecutive patient s. Thirty-one (51.7%) patients were treated because of unstable angina , 11 (18.3%) for post-myocardial infarction (MI) angina, 3 (5.0%) for acute MI, and 15 (25.0%) patients for stable angina. A total of 43 (71 .7%) patients had multivessel disease, 19 (31.7%) had undergone previo us coronary artery bypass graft (CABG), and 17 (28.3%) patients had un dergone multivessel revascularization. The procedure was successful in all patients; and no postprocedural deaths or emergent CABG occurred. Two patients (3.3%) had non-Q-wave MI after the procedure and 1 patie nt(1.7%) experienced Q-wave MI due to subacute stent closure 7 days af ter the procedure. During follow-up ranging from 6 months to 3 years, 2 (3.3%) patients died, 2 (3.3%) required CABG surgery, 1 (1.7%) patie nt had an MI, and 6 patients (10.0%) required target vessel revascular ization. By the quantitative coronary angiography, the initial minimal luminal diameter (MLD) averaged 0.91 +/- 0.45 mm(74.7 +/- 11.8% steno sis) increasing to 3.80 +/- 0.44 mm (-6.7 +/- 12.1%) after the combine d approach procedure. Thirty patients (50.0%) met criteria for late (g reater than or equal to 6 months) angiographic follow-up. Late MLD los s averaged 1.13 +/- 1.07 mm, for a mean net gain of 1.61 +/- 1.23 mm. Available angiographic follow-up evaluation showed a restenosis rate o f 13.3%, A combined approach, defined as the use of both DCA and stent ing, is safe and yields a low restenosis rate in high-risk patients wh o have lesions known to respond less favorably to stenting or DCA alon e. (C) 1998 Wiley-Liss, Inc.