(Circulation. 1997;96:91-98.)
© 1997 American Heart Association, Inc.
Articles |
Randomized Comparison of Angioplasty of Complex Coronary Lesions at a Single Center
Excimer Laser, Rotational Atherectomy, and Balloon Angioplasty Comparison (ERBAC) Study
From Herzzentrum Frankfurt (Germany).
Correspondence to Nicolaus Reifart, MD, Herzzentrum Frankfurt, PO Box 10 10 63, D-60010 Frankfurt am Main, Germany.
Background The purpose of this study was to test whether coronary revascularization with ablation of either excimer laser or rotational atherectomy can improve the initial angiographic and clinical outcomes compared with dilatation (balloon angioplasty) alone.
Methods and Results At a single center, a total of 685 patients with symptomatic coronary disease warranting elective percutaneous revascularization for a complex lesion were randomly assigned to balloon angioplasty (n=222), excimer laser angioplasty (n=232), or rotational atherectomy (n=231). The primary end point was procedural success (diameter stenosis <50%, absence of death, Q-wave myocardial infarction, or coronary artery bypass surgery). The patients who underwent rotational atherectomy had a higher rate of procedural success than those who underwent excimer laser angioplasty or conventional balloon angioplasty (89% versus 77% and 80%, P=.0019), but no difference was observed in major in-hospital complications (3.2% versus 4.3% versus 3.1%, P=.71). At the 6-month follow-up, revascularization of the original target lesion was performed more frequently in the rotational atherectomy group (42.4%) and the excimer laser group (46.0%) than in the angioplasty group (31.9%, P=.013).
Conclusions Procedural success of rotational atherectomy is superior to laser angioplasty and balloon angioplasty; however, it does not result in better late outcomes. The role of plaque debulking before balloon dilatation in percutaneous coronary revascularization remains to be fully defined.
Key Words: angioplasty • lasers • atherectomy
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