High frequency rotational ablation: an alternative in treating coronary artery stenoses and occlusions.
Open Access
- 1 October 1993
- Vol. 70 (4) , 327-336
- https://doi.org/10.1136/hrt.70.4.327
Abstract
OBJECTIVE--To prove the safety and effectiveness of high frequency rotational ablation of coronary artery stenoses and occlusion in humans. SUBJECTS--106 patients with symptoms (91 men, 15 women) who had 67 significant stenoses, mainly types B and C, and 46-chronic occlusions. MAIN OUTCOME MEASURES--Mean change in diameter stenosis after rotational angioplasty alone and in combination with percutaneous transluminal coronary angioplasty immediately after treatment and 24 hours and six months later; restenosis rates at six months; complication of treatment. RESULTS--Rotational ablation could not be used in five stenoses and 16 chronic occlusions because of inability to reach or cross the lesion with the Rotablator guide wire. In four cases rotational ablation failed. Initial angiographic and clinical success by rotational ablation was achieved in 40 of the 67 stenoses (60%) and in 18 of the 46 chronic occlusions (39%). Additional balloon angioplasty was performed in 45 patients, increasing the success rates to 79% and 54%, respectively. In the 62 stenoses treated by rotational ablation the angiographic diameter stenoses were reduced from 76% (SD 14%) to 32% (14%) after Rotablator treatment alone and from 75% (11%) to 33% (17%) with additional balloon angioplasty. In the 30 chronic occlusions treated by rotational ablation the angiographic diameter stenoses were reduced to 38% (18%). At six months angiographic restenosis was evident in nine of the 25 (36%) stenoses treated with rotational ablation alone, in seven of the 22 (32%) stenoses treated with rotational and balloon angioplasty, and in 14 of the 24 (58%) chronic occlusions. There were no procedural deaths and two patients (2%) underwent emergency coronary artery bypass grafting. Although no transmural infarction occurred, there were five (6%) non-Q wave infarctions (two embolic side branch occlusions, two subacute occlusions, and one acute occlusion). Clinically insignificant slight increases in creatine kinase activity were seen in five patients (6%). Severe coronary artery spasm unresponsive to medical treatment was provoked in seven cases (8%). CONCLUSIONS--High frequency rotational ablation is a safe and effective method for treating type B and C coronary artery lesions with results comparable to percutaneous transluminal coronary balloon angioplasty. The combined use of rotational ablation and balloon angioplasty is feasible and is necessary in about half of all procedures, in most cases because the lumen created by the biggest burr is too small.Keywords
This publication has 46 references indexed in Scilit:
- Restenosis following coronary angioplastyAmerican Heart Journal, 1990
- Percutaneous Transluminal Coronary Angioplasty in 1985–1986 and 1977–1981New England Journal of Medicine, 1988
- Rotational atherectomy in atherosclerotic rabbit iliac arteriesAmerican Heart Journal, 1988
- Thromboxane release during percutaneous transluminal coronary angioplastyAmerican Heart Journal, 1986
- In-hospital morbidity and mortality in patients undergoing elective coronary angioplasty.Circulation, 1985
- Increased vasoconstrictor activity of proximal coronary arteries with endothelial damage in intact dogs.Circulation, 1984
- Emergency coronary bypass surgery after coronary angioplasty: the national heart, lung, and blood institute's percutaneous transluminal coronary angioplasty registry experienceThe American Journal of Cardiology, 1984
- Transluminal angioplasty in experimental atherosclerosis. Analysis for embolization using an in vivo perfusion system.Circulation, 1982
- Release of atherosclerotic debris after transluminal angioplasty.Circulation, 1982
- Coronary-Artery Spasm Immediately after Myocardial RevascularizationNew England Journal of Medicine, 1981