title: Rotational atherectomy for in-stent restenosis: acute and long-term results of the first 100 cases.
abstract: OBJECTIVE
  This study evaluated the clinical safety and long-term results of rotational atherectomy (RA) followed by low-pressure balloon dilatation (percutaneous transluminal coronary angioplasty [PTCA]) for the treatment of in-stent restenosis (ISR).
  
  
  BACKGROUND
  In-stent restenosis is associated with a high incidence of recurrence after interventional treatment. Because ISR is due to neointimal hyperplasia, rotational ablation may be a more effective treatment than PTCA.
  
  
  METHODS
  Between November 1995 and November 1996, 100 consecutive patients with first-time ISR were treated by RA. Quantitative coronary angiography and intravascular ultrasound (IVUS) were used to analyze the acute procedural results. The incidence of repeat in-stent restenosis and target vessel revascularization (TVR) at follow-up was determined.
  
  
  RESULTS
  Procedural success without any major in-hospital complications was achieved in 100% of cases. Slow flow was observed in 3% and creatine kinase-MB enzyme elevation >3x normal occurred in 2%. The mean burr-to-artery ratio was 0.68+/-0.18 and adjuvant balloon dilatation was performed at 4.2+/-2.1 atm. Minimum luminal diameter increased from 0.86+/-0.28 mm to 1.89< or =0.21 mm after RA and to 2.56+/-0.29 mm after adjunct PTCA. Quantitative IVUS analysis showed that 77% of the luminal gain occurred due to rotational ablation of the restenotic tissue and only 23% occurred after adjunct balloon dilation, and further stent expansion did not contribute to the luminal enlarge. ment. At a mean follow-up of 13+/-5 months, repeat in-stent restenosis occurred in 28% of patients with TVR of 26%. Univariate predictors of repeat restenosis were burr-to-artery ratio <0.6, ISR in <90 days of stenting, ostial lesion, stent for a restenotic lesion and diffuse type ISR.
  
  
  CONCLUSIONS
  Rotational atherectomy is a safe and feasible technique for treatment of ISR and is associated with a relatively low recurrent restenosis in comparison to historical controls of balloon angioplasty.
authors.affiliation: Cardiac Catheterization Laboratory of the Zena & Michael A. Wiener Cardiovascular Institute, Mount Sinai School of Medicine, New York, New York 10029-6574, USA. ssharma@smtplink.mssm.edu
authors.forename: S K
authors.initials: SK
authors.lastname: Sharma
authors.forename: S
authors.initials: S
authors.lastname: Duvvuri
authors.forename: G
authors.initials: G
authors.lastname: Dangas
authors.forename: A
authors.initials: A
authors.lastname: Kini
authors.forename: R
authors.initials: R
authors.lastname: Vidhun
authors.forename: K
authors.initials: K
authors.lastname: Venu
authors.forename: J A
authors.initials: JA
authors.lastname: Ambrose
authors.forename: J D
authors.initials: JD
authors.lastname: Marmur
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects; D017225:Atherectomy, Coronary; D017023:Coronary Angiography; D003327:Coronary Disease / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D012449:Safety; D015607:Stents / Q000009:adverse effects; D018084:Ultrasonography, Interventional