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      High-Speed Rotational Atherectomy in the Treatment of Bifurcation-Type Coronary Lesions

      , ,

      Cardiology

      S. Karger AG

      Bifurcational angioplasty, Bifurcation lesions, Rotational atherectomy

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          Abstract

          Background: Bifurcational coronary lesions present a major interventional challenge. The differential cutting mechanism of high-speed rotational atherectomy (HSRA) may provide a favourable technique of treating this complex lesion subtype. Methods: We evaluated the use of HSRA (32 lesions) compared to balloon angioplasty (BA) (118 lesions), with provisional stenting in both groups, in a non-randomised, retrospective study of 150 bifurcation-type lesions. Results: The HSRA/stent group had a high primary success rate of 97%, an acceptably low in-hospital event rate of 9% and an overall major adverse cardiac event (MACE) rate at a mean follow-up period of 15 ± 3.4 months of 22.5% with a target lesion revascularisation (TLR) rate of 18.7%. Procedural success in the BA/stent group was 81% with an in-hospital event rate of 14.4%, and the overall MACE rate at follow-up was 27.5% with a TLR rate of 23%. We achieved a greater acute gain in minimal luminal diameter and a lesser percentage of residual stenosis after intervention in the HSRA/stent group compared to the BA/stent group (p < 0.01). Outcome at follow-up favoured the HSRA/stent group, although the difference did not reach statistical significance. Conclusion: HSRA with provisional stenting provided a safe and effective means of treating bifurcation lesions.

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          Most cited references 3

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          Mechanical debulking versus balloon angioplasty for the treatment of true bifurcation lesions.

          The purpose of this study was to compare the immediate angiographic and long-term results of debulking versus balloon angioplasty for treatment of true bifurcation lesions. Previous studies have shown true bifurcation lesions to be a high risk morphological subset for percutaneous transluminal coronary angioplasty (PTCA). Although atherectomy devices have been used to treat bifurcation lesions, no studies have compared the outcomes of these alternative treatment modalities. Between January 1992 and May 1997, we treated 70 consecutive patients with true bifurcation lesions (defined as a greater than 50% stenosis in both the parent vessel and contiguous side branch) with conventional PTCA (n = 30) or debulking (with rotational or directional atherectomy) plus adjunctive PTCA (n = 40). Paired angiograms were analyzed by quantitative angiography, and clinical follow-up was obtained in all patients. Acute procedural success was 73% in the PTCA group and 97% in the debulking group (p = 0.01). Major in-hospital complications occurred in two patients in the PTCA group and one in the debulking group. Treatment with atherectomy plus PTCA resulted in lower postprocedure residual stenoses than PTCA alone (16+/-15% vs. 33+/-17% in the parent vessel, and 6+/-15% vs. 39+/-22% in the side branch; p 2.3 mm, longer lesion lengths, and treatment with PTCA alone. For the treatment of true bifurcation lesions, atherectomy with adjunctive PTCA is safe, improves acute angiographic results, and decreases target vessel revascularization compared to PTCA alone. The benefits of debulking for bifurcation lesions were especially seen in lesions involving large side branches.
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            • Record: found
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            Trouser-like stenting: A new technique for bifurcation lesions

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              • Article: not found

              Removal of focal atheromatous lesions by angioscopically guided high-speed rotary atherectomy

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                Author and article information

                Journal
                CRD
                Cardiology
                10.1159/issn.0008-6312
                Cardiology
                S. Karger AG
                0008-6312
                1421-9751
                2001
                September 2001
                13 September 2001
                : 95
                : 4
                : 198-205
                Affiliations
                King’s College Hospital, London, UK
                Article
                47372 Cardiology 2001;95:198–205
                10.1159/000047372
                11585995
                © 2001 S. Karger AG, Basel

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                Page count
                Figures: 4, Tables: 5, References: 19, Pages: 8
                Categories
                Catheterization and Interventional Cardiology

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