Restenosis after directional coronary atherectomy

• Published in: Journal of the American College of Cardiology 1992-09, Vol.20 (3), p.623-632
• Main Authors: Hinohara, Tomoaki, Robertson, Gregory C., Selmon, Matthew R., Vetter, James W., Rowe, Michael H., Braden, Lissa J., McAuley, Bruce J., Sheehan, Dennis J., Simpson, John B.
• Format: Article
• Language: English
• Subjects: Aged; Biological and medical sciences; Blood Vessel Prosthesis; Cardiac Catheterization - methods; Cardiology. Vascular system; Coronary Artery Disease - epidemiology; Coronary Artery Disease - surgery; Coronary heart disease; Coronary Vessels - surgery; Female; Follow-Up Studies; Heart; Humans; Incidence; Male; Medical sciences; Middle Aged; Recurrence; Risk Factors; Saphenous Vein - surgery; Treatment Outcome
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/0735-1097(92)90017-H

Objectives. This study evaluates the incidence of restenosis after successful directional coronary atherectomy and identifies risk factors for restenosis. Background. Directional coronary atherectomy has been shown to be a safe and effective treatment of obstructive coronary artery disease; however, information regarding restenosis is limited. Methods. Between October 1986 and December 1989, 289 patients with 332 lesions were successfully treated with directional coronary atherectomy and followed up prospectively. Clinical follow-up information was available for 98% and angiographic follow-up information was obtained for 82% at approximately 6 months, or earlier if symptoms recurred. Angiograms were quantitatively analyzed. Restenosis was defined as > 50% stenosis at the site of intervention. Results. Seventy-four percent of patients were either asymptomatic or clinically improved after the procedure. Thirty-two percent were subsequently treated by coronary artery bypass surgery (14%), percutaneous transluminal coronary angioplasty (4%) or repeat atherectomy (13%). Angiographic evidence of restenosis was observed in 42%. The restenosis rate in native coronary arteries was 31 % for primary lesions and 28% and 49%, respectively, for lesions treated with one or two previous angioplasty procedures. The restenosis rate for saphenous vein grafts was 53% for primary lesions and 58% and 82%, respectively, for lesions treated with one or two previous angioplasty procedures. The median interval to angiographically documented restenosis was 133 days. A higher restenosis rate was associated with a saphenous vein graft, hypertension, a longer lesion (≥ 10 mm), a smaller vessel diameter (< 3 mm), a noncalcified lesion and use of a smaller (6F) device. Conclusions. Restenosis remains a limitation of directional coronary atherectomy. A subset of patients with larger vessels, shorter lesions or lesions treated with a larger (7F) device may have a more favorable outcome.