title: Directional coronary atherectomy for the treatment of Palmaz-Schatz in-stent restenosis.
abstract: Management of in-stent restenosis has become a significant challenge in interventional cardiology. The results of balloon angioplasty have been disappointing due to the high recurrence of restenosis at follow-up. Debulking of the restenotic tissue within the stents using directional coronary atherectomy (DCA) may offer a therapeutic advantage. We report the immediate clinical and angiographic outcomes and long-term clinical follow-up results of 45 patients (46 lesions), mean age 63+/-12 years, 73% men, with a mean reference diameter of 2.9+/-0.6 mm, treated with DCA for symptomatic Palmaz-Schatz in-stent restenosis. DCA was performed successfully in all 46 lesions and resulted in a postprocedural minimal luminal diameter of 2.7+/-0.7 mm and a residual diameter stenosis of 17+/-10%. There were no in-hospital deaths, Q-wave myocardial infarctions, or emergency coronary artery bypass surgeries. Four patients (9%) suffered a non-Q-wave myocardial infarction. Target lesion revascularization was 28.3% at a mean follow-up of 10+/-4.6 months. Kaplan-Meier event-free survival (freedom from death, myocardial infarction, and repeat target lesion revascularization) was 71.2% and 64.7% at 6 and 12 months after DCA, respectively. Thus, DCA is safe and efficacious for the treatment of Palmaz-Schatz in-stent restenosis. It results in a large postprocedural minimal luminal diameter and a low rate of both target lesion revascularization and combined major clinical events at follow-up.
authors.affiliation: Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston 02114, USA. mahdi.nasser@mgh.harvard.edu
authors.forename: N A
authors.initials: NA
authors.lastname: Mahdi
authors.forename: A Z
authors.initials: AZ
authors.lastname: Pathan
authors.forename: L
authors.initials: L
authors.lastname: Harrell
authors.forename: M N
authors.initials: MN
authors.lastname: Leon
authors.forename: J
authors.initials: J
authors.lastname: Lopez
authors.forename: A
authors.initials: A
authors.lastname: Butte
authors.forename: M
authors.initials: M
authors.lastname: Ferrell
authors.forename: H K
authors.initials: HK
authors.lastname: Gold
authors.forename: I F
authors.initials: IF
authors.lastname: Palacios
mesh_terms: D000800:Angioplasty, Balloon; D017225:Atherectomy, Coronary / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012044:Regression Analysis; D015607:Stents; D016896:Treatment Outcome; D014463:Ultrasonography