Lower restenosis rate with stenting following aggressive versus less aggressive rotational atherectomy

Yoshio Kobayashi, Joseph De Gregorio, Nobuyuki Kobayashi, Tatsuro Akiyama, Bernhard Reimers, Issam Moussa, Carlo Di Mario, Leo Finci, Antonio Colombo

Research output: Contribution to journalArticlepeer-review

Abstract

The present study evaluated the acute and follow-up results of stenting following aggressive rotational atherectomy compared with stenting following less aggressive rotational atherectomy. Recent work has demonstrated that stenting following rotational atherectomy is a promising strategy for complex and calcified lesions. However, there is little information available regarding the optimal procedural technique of rotational atherectomy to be employed before stent implantation. Between May 1995 and February 1997, 162 lesions in 126 patients were stented following rotational atherectomy because of the presence of severe calcification on fluoroscopy or intravascular ultrasound (95%). The lesions were divided as to whether aggressive rotational atherectomy was performed or not. Aggressive rotational atherectomy, defined as the use of a final burr size ≥2.25 mm and/or final burr/vessel ratio ≥0.8, was performed in 56 lesions. A less aggressive rotational atherectomy strategy was performed in 106 lesions. Procedural Q- wave (8.9% vs. 1.9%, P <0.05) and non-Q-wave (11% vs. 1.9%, P <0.05) myocardial infarctions were observed more frequently after aggressive rotational atherectomy; there was no significant difference in the incidence of other procedural complications. Although there was no significant difference in minimal lumen diameter after the procedure (3.11 ± 0.68 vs. 2.99 ± 0.48 mm, NS), at follow-up a greater minimal lumen diameter was observed in the lesions treated with aggressive rotational atherectomy compared to those treated with less aggressive rotational atherectomy (2.12 ± 1.31 vs. 1.56 ± 0.89 mm, P <0.01). Restenosis rates were 50.0% in the lesions treated without aggressive rotational atherectomy and 30.9% in those treated with aggressive rotational atherectomy (P <0.05). There was no significant difference in the incidence of restenosis with a focal pattern between the two groups (25.0% vs. 21.4%, NS). In contrast, restenosis with a diffuse pattern was lower in lesions treated with aggressive rotational atherectomy than in those without aggressive rotational atherectomy (9.5% vs. 25.0%, P <0.05). Aggressive rotational atherectomy followed by stenting is a promising strategy to reduce the restenosis rate in calcified lesions. However, the aggressive strategy is associated with an increased risk of procedural myocardial infarction.

Original languageEnglish
Pages (from-to)406-414
Number of pages9
JournalCatheterization and Cardiovascular Interventions
Volume46
Issue number4
DOIs
Publication statusPublished - Apr 1999

Keywords

  • Angioplasty
  • Coronary disease
  • Restenosis
  • Stents

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging

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