Circulation, Vol 82, 69-79, Copyright © 1990 by American Heart Association
RD Safian, JS Gelbfish, RE Erny, SJ Schnitt, DA Schmidt and DS Baim
Between August 5, 1988 and August 1, 1989, we attempted percutaneous
directional coronary atherectomy of 76 lesions, including 42 primary
lesions and 34 restenosis lesions that developed after one or more prior
interventions. The procedure was successful in 67 lesions (88%), with a
decrease in diameter stenosis from 80 +/- 11% to 5 +/- 15% after
atherectomy (p less than 0.01). One or more complications occurred in six
patients (9%), including non-Q wave myocardial infarction (three patients,
4.5%), femoral arterial injury requiring surgical repair (two patients,
3%), and proximal dissection leading to emergency bypass surgery (one
patient, 1.5%). Despite these favorable acute results, the 6-month lesion
restenosis rate was 30% by life-table analysis. Light microscopy of
retrieved tissue revealed atherosclerotic plaque in 94%, media in 67%, and
adventitia in 27%. Intimal proliferation was present in 97% of the
restenosis lesions but was also evident in 33% of primary lesions. Tissue
weight from 27 lesions averaged 18.5 mg (range, 5.8- 45.1 mg), which is not
adequate to explain the entire angiographic improvement. Thus, part of the
improvement in lumen diameter appears to be due to mechanical dilatation
rather than to tissue removal alone. Atherectomy can predictably treat
selected coronary lesions with overall safety comparable to that of
conventional balloon angioplasty, although the procedure as currently
performed does not derive all of its benefit from tissue removal and does
not appear to prevent restenosis.
ARTICLES
Coronary atherectomy. Clinical, angiographic, and histological findings and observations regarding potential mechanisms
Charles A. Dana Research Institute, Beth Israel Hospital, Boston, MA 02215.
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