[Restenosis after optimal coronary atherectomy and influence on left ventricular function].
The authors prospectively assessed 95 patients undergoing optimal guided atherectomy to assess the incidence of restenosis at 6 months. The coronary lesions were measured by a system of quantitative angiography to ensure reproducibility. Ventricular volumes, ejection fraction and segmental wall motion were assessed by ventriculography performed in the right anterior oblique projection. Sixty-three patients underwent atherectomy of the left anterior descending artery and 32 patients of the right coronary artery. The reference diameter was 3.58 +/- 0.65 mm. Atherectomy increased the minimal diameter of the lesion from 1.19 +/- 0.44 to 3.03 +/- 0.45 mm, with a residual stenosis of 14 +/- 10% of the diameter. At 6 months, 23% of patients had restenosed (> 50% stenosis) with a residual lumen at 1.16 +/- 0.39 mm. In the absence of restenosis, there was no significant change in left ventricular volumes or pressures and the global ejection fraction increased by +4 +/- 9% (p < 0.01), mainly in the group undergoing left anterior descending atherectomy. Moreover, fractional shortening increased in the anterior segments (+11 +/- 18%; p < 0.001). The authors conclude that optimal atherectomy is associated with acceptable rates of restenosis and that medium-term benefits of segmental wall motion are observed in patients without angiographic restenosis, mainly in those undergoing the procedure on the left anterior descending artery.
Coste
P
P
IFR Coeur-Vaisseaux-Thrombose Inserm 4, CNRS FR21, service de soins intensifs et de cardiologie interventionnelle.
Dos Santos
P
P
Sempe
S
S
Moussari
A
A
Jaïs
C
C
Duclos
F
F
Besse
P
P
D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D017225:Atherectomy, Coronary / Q000295:instrumentation / Q000379:methods*; D017023:Coronary Angiography; D003327:Coronary Disease / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction; D011446:Prospective Studies; D012008:Recurrence; D016896:Treatment Outcome; D016277:Ventricular Function, Left
Resténose après athérectomie coronaire optimale et influence sur la fonction du ventricule gauche.