730-1 Angioscopy Guided Simpson Atherectomy – New Insights into Early Directional Coronary Atherectomy Results

• Published in: Journal of the American College of Cardiology 1995-02, Vol.25 (2), p.137A-137A
• Main Authors: Thieme, Torsten, Felix, Stefan B., Meyer, Rudolf, Peter Dübel, Hans, Gliech, Volker, Baumann, Gert, Kleber, Franz X.
• Format: Article
• Language: English
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/0735-1097(95)92022-W

Restenosis and acute complication rate in angioplasty are closely related to acute angiographic results. Short and longterm outcome after Simpson atherectomy (DCA) has not yet yielded better results than PTCA. We used angioscopy guided atherectomy to further improve atherectomy results and to gain new insights into discrepancies between excellent angiographic results and considerable complication and restenosis rate. 100 DCAs were performed in 97 pts in 63 LAD, 23 RCA, 12 CX, 1 diagonal branch and 1 bypass graft lesions. In 80 pts 83 elective, preplanned procedures and in 17 pts rescue procedures were performed. Initial angiographic success was achieved in 86% with DCA and in 90.4% with DCA plus adjunctive PTCA. Coronary angiography after DCA revealed the large size, smooth contour lumina that are known for this procedure. The table shows results in the elective DCA procedures.Angiographic resultspre DCAatter DCAatter DCA + PTCA% diameter stenosis71.125.521.1MLD(mm)0.912.372.63 In 63 of these pts DCA was combined with angioscopy before andlor after DCA and adjunctive PTCA in a total of 169 angioscopic procedures. Baxter 4.5-Fr. angioscopy catheters were used. Angioscopy post DCA revealed highly irregular lumina with typical grooves, large protrusions of atherosclerotic material and considerable residual luminal narrowing. The distribution of the grooves into diverse directions of the 360° vessel lumen explains the smooth endoluminal surface found in coronary angiography, which contrasts with the angioscopic results. Post DCA PTCA markedly improves angioscopic results with smoother surface and enlarged lumina. Angiographic findings after DCA are misleading. Angioscopically highly irregular surfaces with significant residual stenoses are found. Angioscopy guided atherectomy and PTCA after DCA lead to better results.