TREATMENT STRATEGIES FOR LONG AND CALCIFIED LESIONS

This study discusses the treatment strategies used to approach long le sions, lesions in small vessels, and calcified lesions. Traditional tr eatment strategies for these lesion subtypes have yielded high acute c omplication rates and poor long-term outcome. A prospective analysis o f 160 lesions was performed using intravascular ultrasound (IVUS) guid ed PTCA for the treatment of long lesions and lesions in small vessels , while a retrospective analysis of 106 calcified lesions was performe d that were treated with the combination of rotablation and stenting. Acute and short-term results of IVUS guided PTCA with spot stenting sh ow a 30-day major adverse cardiac event rate (MACE) of 5% with a high procedural success rate (96%), while the long-term outcome resulted in an agiographic restenosis rate of 17.4% and a target lesion revascula rization rate of 13%. The combination of rotablation and stenting also rendered results in calcified lesions of a 93% angiographic success r ate and a long-term outcome of restenosis of 22.5%. Optimal coronary s tenting after rotational atherectomy in calcified lesions can be perfo rmed with a high success rate, an acceptable rate of procedural compli cations, and a low rate of stent thrombosis. This approach was associa ted with a low incidence of angiographic restenosis compared with resu lts obtained with other interventional approaches. IVUS guided PTCA wi th spot stenting allows safe treatment of long lesions and lesions in small vessels. Shout-term and long-term outcomes including 6-month MAC E and angiographic restenosis appear to be better than results achieve d in historical controls that utilize balloon angioplasty alone or ste nts in a manner where the lesion is covered from the proximal normal s egment to the distal normal segment.