title: Restenosis after directional coronary atherectomy.
abstract: OBJECTIVE
  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 greater than 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 (greater than or equal to 10 mm), a smaller vessel diameter (less than 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.
authors.affiliation: Pacific Foundation for Cardiovascular Research, Redwood City, California 94062.
authors.forename: T
authors.initials: T
authors.lastname: Hinohara
authors.forename: G C
authors.initials: GC
authors.lastname: Robertson
authors.forename: M R
authors.initials: MR
authors.lastname: Selmon
authors.forename: J W
authors.initials: JW
authors.lastname: Vetter
authors.forename: M H
authors.initials: MH
authors.lastname: Rowe
authors.forename: L J
authors.initials: LJ
authors.lastname: Braden
authors.forename: B J
authors.initials: BJ
authors.lastname: McAuley
authors.forename: D J
authors.initials: DJ
authors.lastname: Sheehan
authors.forename: J B
authors.initials: JB
authors.lastname: Simpson
mesh_terms: D000368:Aged; D001807:Blood Vessel Prosthesis; D006328:Cardiac Catheterization / Q000379:methods*; D003324:Coronary Artery Disease / Q000453:epidemiology / Q000601:surgery*; D003331:Coronary Vessels / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012307:Risk Factors; D012501:Saphenous Vein / Q000601:surgery; D016896:Treatment Outcome