title: [Directional coronary atherectomy: acute results and angiography follow-up in 42 treated patients].
abstract: We used directional coronary atherectomy (DCA) as a therapeutic option for coronary lesions unsuitable for PTCA (eccentric, ostial, branching or restenotic) and as "rescue device" for failed PTCA. Forty-two patients were treated by DCA using the Simpson coronary atherectomy device, including four female and 38 male patients with an average age of 55.7 years. Atherectomy as primary intervention was performed in 16 patients (Group I), because morphology of their lesions was assumed to be unsuitable for PTCA. DCA was also used after failed balloon dilatation in eight patients with unsuccessful, but uneventful treatment (Group II). In 18 cases (Group III) DCA was performed as "rescue procedure" after failed PTCA and resulting critical ischemia (local dissection, signs and symptoms of ongoing ischemia, occlusion after PTCA). Target lesions were located in LM 1, LAD 33, RCA 9, CABG 3. Mean length of lesion was 8.1 mm (2-25 mm). The overall success rate for 46 lesions was 93%. Mean stenosis was reduced from 92% to 17% in cases with primary success. Presently, available follow-up angiography (24) showed six restenoses (defined as greater than 50% stenoses). Major complications occurred in seven cases (death: 0, MI: 2, CABG within 24 h: 5; 3 in Group III). "Rescue indication" (Group III) after failed balloon dilatation procedure showed a favorable primary result with a success rate of 78%; only three cases of this group needed CABG. Our results show that DCA is a safe and effective technique which can extend the indication for percutaneous procedures and gives a successful nonoperative option in cases of failed PTCA.
authors.affiliation: Medizinische Klinik I, Ludwig-Maximillians-Universität München.
authors.forename: B
authors.initials: B
authors.lastname: Höfling
authors.forename: P
authors.initials: P
authors.lastname: Gonschior
authors.forename: G
authors.initials: G
authors.lastname: Bauriedel
authors.forename: D
authors.initials: D
authors.lastname: Backa
authors.forename: A
authors.initials: A
authors.lastname: von Pölnitz
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000295:instrumentation; D003131:Combined Modality Therapy; D017023:Coronary Angiography; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000601:surgery*; D003331:Coronary Vessels / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence
vernacular_title: Gerichtete koronare Atherektomie: Akutergebnisse und angiographische Verlaufskontrolle bei 42 behandelten Patienten.