(Circulation. 1997;96:128-136.)
© 1997 American Heart Association, Inc.
Articles |
Coronary Stenting After Rotational Atherectomy in Calcified and Complex Lesions
Angiographic and Clinical Follow-Up Results
From the Centro Cuore Columbus (I.M., C. Di M., B.R., L. Di F., G.M., A.C.), Milan, Italy; Lenox Hill Hospital (J.M.), New York, NY; and the Department of Cardiology, University of California (J.T.), Irvine.
Correspondence to Antonio Colombo, MD, Centro Cuore Columbus, Via M. Buonarotti 48, 20145 Milan, Italy.
Background Treatment of calcified (in contrast to simple) lesions with PTCA has been associated with a lower success rate and more procedural complications. Rotablation can improve acute results, but the high restenosis rate remains a problem. The purpose of this study was to evaluate the clinical and angiographic outcome of patients with complex and calcified lesions treated with a combination of rotablation and stenting.
Methods and Results Seventy-five consecutive patients with 106 lesions had rotablation prior to coronary stenting. Intravascular ultrasound–guided stenting was used without subsequent anticoagulation in 93% of patients. Procedural success was achieved in 93.4% of lesions. Acute stent thrombosis occurred in two lesions (1.9%), and subacute stent thrombosis in one lesion (0.9%). Angiographic follow-up was performed in 82.5% of lesions at 4.6±1.9 months with an angiographic restenosis rate of 22.5%. Clinical follow-up was performed in all patients at 6.4±3 months; target lesion revascularization was needed in 18% of lesions, Q-wave myocardial infarction occurred in 1.3%, coronary bypass surgery in 4.0%, and death in 1.3%.
Conclusions Optimal coronary stenting after rotablation in calcified and complex lesions can be performed with a high success rate, an acceptable rate of procedural complications, and a low rate of stent thrombosis. This approach was associated with a low incidence of angiographic restenosis compared with results usually obtained with other interventional strategies in calcified and complex lesion subsets.
Key Words: stents • balloon • calcium
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