title: Novel approach to rotational atherectomy results in low restenosis rates in long, calcified lesions: long-term results of the San Antonio Rotablator Study (SARS).
abstract: Ablation technique and adjunctive strategy may affect restenosis after rotational atherectomy. To minimize trauma to the vascular wall, we changed the technique of rotablation as follows: the RPM range was decreased to 140,000-160,000 RPM, the ablation was performed using a repetitive pecking motion, avoiding a decrease in the rotational speed of the burr greater than 3,000 RPM, long lesions were divided into segments and each segment was separately ablated, and the burr-to-artery ratio was intended to be approximately 0.75. To prevent coronary spasm, before and after each pass, 100-200 microg nitroglycerin and 100-200 microg verapamil i.c. boluses were administered. Adjunctive PTCA was performed using a closely sized 1.1:1 balloon-to-artery ratio with a noncompliant balloon at low pressures for 120 sec. The study incorporated 111 patients with a combined total of 146 calcified lesions. Results. A total of 31.5% of patients underwent a multivessel procedure. No deaths occurred. Q-wave MI and/or creatine kinase elevation greater than three times baseline levels occurred in 4.5% of patients. By quantitative coronary angiography (QCA), the reference vessel diameter was 3.13+/-0.59 mm, mean lesion length was 33.41+/-18.58 mm. Percent stenosis and mean luminal diameter were as follows: at baseline 75.7%+/-10.8%, or 0.76+/-0.41mm, Post-rotational atherectomy 41.5%+/-3.6%, or 1.83+/-0.43 mm, Post-PTCA 18.2%+/-11.9%, or 2.56+/-0.50 mm. Six-month angiographic follow-up was available in 64 (57.7%) pts. Net luminal gain was 1.15+/-0.76 mm, with a late luminal loss of 0.65+/-0.84 mm. The mean diameter stenosis at follow-up was 37.6%+/-28.5%, with MLD 1.91+/-1.21 mm. The binary restenosis rate was 28.1%. Therefore, modification of rotational atherectomy technique with adjunctive PTCA resulted in a favorable restenosis rate in long, calcified lesions. Cathet. Cardiovasc. Intervent. 48:48-53, 1999.
authors.affiliation: Department of Medicine, Division of Cardiology, University of Texas Health Science Center, San Antonio, Texas 78284, USA. kiesz@uthscsa.edu
authors.forename: R S
authors.initials: RS
authors.lastname: Kiesz
authors.forename: M M
authors.initials: MM
authors.lastname: Rozek
authors.forename: D G
authors.initials: DG
authors.lastname: Ebersole
authors.forename: D M
authors.initials: DM
authors.lastname: Mego
authors.forename: C W
authors.initials: CW
authors.lastname: Chang
authors.forename: R L
authors.initials: RL
authors.lastname: Chilton
mesh_terms: D015906:Angioplasty, Balloon, Coronary; D017225:Atherectomy, Coronary / Q000295:instrumentation / Q000379:methods*; D002114:Calcinosis / Q000473:pathology / Q000628:therapy; D017023:Coronary Angiography; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D003331:Coronary Vessels / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence