ACUTE AND LATE CLINICAL OUTCOME AFTER ROTATIONAL ATHERECTOMY FOR COMPLEX CORONARY-DISEASE

Rotational atherectomy is effective acutely in treating complex corona ry disease, but less is known about its long-term clinical outcome. We examined the acute results and late clinical outcome in 178 patients undergoing treatment with this device. Rotational atherectomy was used to treat 240 lesions in 178 individual patients. Nineteen percent had multilesion or staged multivessel procedures, and 71% had AHA-ACC Typ e B-2/C lesions, The procedure was completed successfully in 94% of pa tients. Major complications occurred in 6% (death 1%, Q-MI 2.8%, and e mergency bypass surgery 2.2%), Clinical follow-up was available for 16 7 (94%) patients at 13 +/- 6 months. Thirty-five percent required addi tional catheterization because of recurrent symptoms or an abnormal st ress test. Clinical restenosis was confirmed in 18%, and an additional 2.2% of patients had progression of disease in previously untreated s egments. At the end of 1 year, 14% had undergone repeat target vessel revascularization. Cumulatively at follow-up, approximately 80% had av oided an acute major complication and repeat revascularization for res tenosis, Rotational atherectomy provides excellent acute and good late clinical results. At 1 year follow-up, the likelihood of developing c linical restenosis or significant progression of disease was 1 in 5, a nd patients had al in 7 chance of requiring revascularization because of restenosis. These findings are encouraging and indicate that rotati onal atherectomy can be performed safely and with a high degree of acu te and late clinical success in complex coronary disease characterized by multivessel or multilesion involvement and a predominance of B-2 a nd C lesions. (C) 1998 Wiley-Liss, Inc.