Novel approach to rotational atherectomy results in low restenosis rates in long, calcified lesions: Long-term results of the San Antonio Rotablator Study (SARS)

Ablation technique and adjunctive strategy may affect restenosis after rota tional atherectomy To minimize trauma to the vascular wall, we changed the technique of rotablation as follows: the RPM range was decreased to 140,000 -160,000 RPM, the ablation was performed using a repetitive pecking motion, avoiding a decrease in the rotational speed of the burr greater than 3,000 RPM, long lesions were divided into segments and each segment was separate ly ablated, and the burr-to-artery ratio was intended to be approximately 0 .75. To prevent coronary spasm, before and after each pass, 100-200 mu g ni troglycerin and 100-200 mu g verapamil i.c. boluses were administered. Adju nctive PTCA was performed using a closely sized 1.1:1 balloon-to-artery rat io with a noncompliant balloon at low pressures for 120 sec. The study inco rporated 111 patients with a combined total of 146 calcified lesions. Results. A total of 31.5% of patients underwent a multivessel procedure. No deaths occurred. CI-wave MI and/or creatine kinase elevation greater than three times baseline levels occurred in 4.5% of patients. By quantitative c oronary angiography (QCA), the reference vessel diameter was 3.13+/-0.59 mm , mean lesion length was 33.41+/-18.58 mm. Percent stenosis and mean lumina l diameter were as follows: at baseline 75.7%+/-10.8%, or 0.76+/-0.41 mm, P ost-rotational atherectomy 41.5%+/-3.6%, or 1.83+/-0.43 mm, Post-PTCA 18.2% +/-11.9%, or 2.56+/-0.50 mm. Six-month angiographic follow-up was available in 64 (57.7%) pts. Net luminal gain was 1.15+/-0.76 mm, with a late lumina l loss of 0.65+/-0.84 mm. The mean diameter stenosis at follow-up was 37.6% +/-28.5%, with MLD 1.91 +/- 1.21 mm. The binary restenosis rate was 28.1%. Therefore, modification of rotational atherectomy technique with adjunctive PTCA resulted in a favorable restenosis rate in long, calcified lesions. ( C) 1999 Wiley-Liss, Inc.