[Efficacy and limitation of directional coronary atherectomy for acute myocardial infarction assessed by depth of tissue resection].
The efficacy and limitations of directional coronary atherectomy (DCA) for acute myocardial infarction were evaluated in 44 patients (left anterior descending artery : 27 lesions, left circumflex artery : 2 lesions, right coronary artery : 15 lesions) who underwent DCA within 24 hours after the onset of chest pain. Thirty-two patients underwent DCA for residual stenosis of > or = 75% with TIMI flow grade II or III after thrombolysis (immediate DCA), and 12 patients underwent DCA for suboptimal results after immediate percutaneous transluminal coronary angioplasty (rescue DCA). In all patients, DCA resulted in residual stenosis of <25% (15 +/- 8%), and the primary success rate was 100%. No major complications (death, emergency bypass grafting) occurred. Repeat angiography was performed in 41 patients before discharge (2.4 +/- 0.7 weeks later) and in 39 patients during follow-up (5 +/- 2 months later). Reocclusion was not found at the follow-up. Restenosis was not found before predischarge, but was found in 19 of the 39 patients (49%) at the follow-up. Histological analysis of atheroma samples was performed to evaluate the influence of subintimal resection on restenosis. Patients were divided into two groups according to the depth of tissue resection : intimal resection and subintimal resection. The restenosis rate associated with subintimal resection was significantly higher than that associated with intimal resection (80% vs 29%, p < 0.01). DCA is useful for persistent patency of the infarct-related coronary artery in patients with acute infarction, but subintimal resection may increase the restenosis rate during the follow-up period.
Kurisu
S
S
Department of Cardiology, Hiroshima City Hospital, Hiroshima.
Sato
H
H
Tateishi
H
H
Kawagoe
T
T
Ishihara
M
M
Shimatani
Y
Y
Sakai
K
K
Matsuura
H
H
D000328:Adult; D000368:Aged; D017225:Atherectomy, Coronary / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000503:physiopathology / Q000601:surgery*; D012008:Recurrence; D014654:Vascular Patency