Coronary stenting after rotational atherectomy in calcified and complex lesions. Angiographic and clinical follow-up results.
BACKGROUND
Treatment of calcified (in contrast to simple) lesions with PTCA has been associated with a lower success rate and more procedural complications. Rotablation can improve acute results, but the high restenosis rate remains a problem. The purpose of this study was to evaluate the clinical and angiographic outcome of patients with complex and calcified lesions treated with a combination of rotablation and stenting.


RESULTS
Seventy-five consecutive patients with 106 lesions had rotablation prior to coronary stenting. Intravascular ultrasound-guided stenting was used without subsequent anticoagulation in 93% of patients. Procedural success was achieved in 93.4% of lesions. Acute stent thrombosis occurred in two lesions (1.9%), and subacute stent thrombosis in one lesion (0.9%). Angiographic follow-up was performed in 82.5% of lesions at 4.6 +/- 1.9 months with an angiographic restenosis rate of 22.5%. Clinical follow-up was performed in all patients at 6.4 +/- 3 months; target lesion revascularization was needed in 18% of lesions; Q-wave myocardial infarction occurred in 1.3%, coronary bypass surgery in 4.0%, and death in 1.3%.


CONCLUSIONS
Optimal coronary stenting after rotablation in calcified and complex lesions can be performed with a high success rate, an acceptable rate of procedural complications, and a low rate of stent thrombosis. This approach was associated with a low incidence of angiographic restenosis compared with results usually obtained with other interventional strategies in calcified and complex lesion subsets.
Moussa
I
I
Centro Cuore Columbus, Milan, Italy.
Di Mario
C
C
Moses
J
J
Reimers
B
B
Di Francesco
L
L
Martini
G
G
Tobis
J
J
Colombo
A
A
D000368:Aged; D001241:Aspirin / Q000008:administration & dosage; D017225:Atherectomy, Coronary; D002114:Calcinosis / Q000000981:diagnostic imaging / Q000628:therapy*; D017023:Coronary Angiography; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000628:therapy*; D003328:Coronary Thrombosis / Q000209:etiology; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage; D005500:Follow-Up Studies; D006493:Heparin / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects; D013988:Ticlopidine / Q000008:administration & dosage; D014463:Ultrasonography; D014859:Warfarin / Q000008:administration & dosage
D005343:Fibrinolytic Agents; D014859:Warfarin; D006493:Heparin; D013988:Ticlopidine; D001241:Aspirin