title: 'Salvage atherectomy' for discrete arterial dissections resulting from balloon angioplasty.
abstract: OBJECTIVE
  To review the outcome of attempted salvage atherectomy performed following failed balloon angioplasty at a single centre.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  All patients undergoing percutaneous directional atherectomy shortly after failed coronary or peripheral balloon angioplasty at St Paul's Hospital, Vancouver, British Columbia, are reported.
  
  
  METHODS
  Salvage atherectomy was performed in six patients following failed balloon angioplasty prior to hospital discharge. In each case, a discrete mural flap resulted in a compromised lumen and ischemia.
  
  
  RESULTS
  Percutaneous directional atherectomy successfully recovered atheromatous intimal fragments with restoration of arterial patency in all patients. Media was identified in one specimen and adventitia in none. Perforation did not occur and there were no complications. One patient had documented restenosis and a second had a significant lesion at a more proximal site with a follow-up of four to 15 months (mean nine). Both patients underwent uncomplicated repeat balloon angioplasty without angiographical dissection.
  
  
  CONCLUSIONS
  Salvage atherectomy has a limited--but still useful--role in the management of discrete, obstructive arterial dissection flaps complicating balloon angioplasty.
authors.affiliation: Division of Cardiology, St Paul's Hospital, University of British Columbia, Vancouver.
authors.forename: J G
authors.initials: JG
authors.lastname: Webb
authors.forename: A A
authors.initials: AA
authors.lastname: Dodek
authors.forename: M
authors.initials: M
authors.lastname: Allard
authors.forename: R
authors.initials: R
authors.lastname: Carere
authors.forename: I
authors.initials: I
authors.lastname: Marsh
mesh_terms: D000328:Adult; D000800:Angioplasty, Balloon / Q000009:adverse effects*; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D016879:Salvage Therapy / Q000379:methods*