Directional coronary atherectomy of in-stent restenosis: A two-center experience

Background: Tissue proliferation is the major cause of in-stent restenosis (ISR). Thus, debulking of material should be the most favorable method to t reat ISR. The present study was performed to test the clinical and angiogra phic outcome of directional coronary atherectomy (DCA) in the treatment of restenosis within different stents. Methods and Results: Fifty patients wit h ISR in single stents (12 Palmaz-Schatz. stents, 8 Pura stents, 10 Multili nk stents, 10 NIR stents, 8 Wallstents, and 2 Microstents) underwent DCA wi th adjunctive balloon angioplasty in. 38 patients. Primary success was achi eved in 48 patients (96%). Two patients developed CK-MB elevations, one wit h a Q-wave infarction. Some minor technical problems occurred with respect to the different stent types. The percent diameter stenosis decreased from 76 +/- 7% at baseline to 29 +/- 6% after atherectomy (P < 0.0001) and 20 +/ - 4% after adjunctive PTCA, and it increased to 45 +/- 19% at 6-month angio graphy (P < 0.0001). Angiographic restenosis occurred in 14 (29.2%) of 48 p atients who were reevaluated after 6 months. Conclusion: While DCA is able to remove a significant amount of intimal tissue in selected patients with in-stent restenosis, new atherectomy catheter designs are required to make this a feasible and safe procedure.