HIGH-SPEED ROTATIONAL CORONARY ATHERECTOMY FOR PATIENTS WITH DIFFUSE CORONARY-ARTERY DISEASE

High speed rotational coronary atherectomy was undertaken using the Rotablator in 42 patients who were suboptimal candidates for balloon angioplasty. Most patients (71%) had diffuse coronary artery disease, defined as a stenosis > 1 cm in length. Previous restenosis after balloon angioplasty was present in 21% and 10% had an ostial lesion. Adjunctive balloon angioplasty was not used to reduce residual stenosis after atherectomy. The procedure was successful in 76% of patients. Procedural success was achieved in 92% of patients with a lesion less-than-or-equal-to 1 cm in length, but in only 70% of patients with a lesion > 1 cm in length (p < 0.01). One patient sustained abrupt closure of the target vessel, resulting in emergency bypass surgery and death. Small non-Q wave myocardial infarction occurred in eight patients (19%) and was associated with a longer lesion. The mean peak creatine kinase value in patients with non-Q wave myocardial infarction was 683 U/liter. Transient regional wall motion abnormalities were noted on the postatherectomy left ventricular angiogram in four of the eight patients with non-Q wave myocardial infarction. Follow-up angiography (at a mean interval of 6.2 +/- 2.6 months) was performed in 91% of patients and revealed restenosis (> 50% narrowing) in 59%. The restenosis rate was 22% for short lesions (less-than-or-equal-to 1 cm) and 75% for long lesions (> 1 cm) (p < 0.05). In this study, the results of high speed rotational coronary atherectomy were strongly influenced by lesion length. Although short lesions (less-than-or-equal-to 1 cm) were treated effectively, longer lesions (> 1 cm) were associated with decreased procedural success, increased procedural complications and a higher restenosis rate.