title: Directional coronary atherectomy vs. rotational atherectomy for the treatment of in-stent restenosis of native coronary arteries.
abstract: Management of in-stent restenosis has become a significant challenge in interventional cardiology. Since the mechanism of in-stent restenosis is predominantly intimal hyperplasia, debulking techniques have been used to treat this condition. This study is a nonrandomized comparison of the immediate and long-term results of directional coronary atherectomy (DCA; n = 58) vs. high-speed rotational atherectomy (ROTA; n = 61) for the treatment of in-stent restenosis of native coronary arteries. There were no in-hospital deaths, Q-wave myocardial infarctions, or emergency coronary artery bypass surgery in either group. DCA resulted in a larger postprocedural minimal luminal diameter of (2.57 +/- 0.51 vs. 2.14 +/- 0.37 mm; P < 0.0001) and a larger acute gain (1.83 +/- 0.52 vs. 1.42 +/- 0.48 mm; P < 0.0001). Furthermore, 12-month clinically indicated target lesion revascularization (39% vs. 21%; P = 0.02) and long-term follow-up MACE (44% vs. 28%; P = 0.03) was greater in the ROTA group. The present study suggests that DCA appears to be superior to ROTA for the treatment of in-stent restenosis of native coronary arteries. Compared to ROTA, the debulking effect of DCA leads to a larger postprocedure minimal luminal diameter, and a lower incidence of subsequent target lesion revascularization and MACE.
authors.affiliation: Cardiac Unit, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Pedro L
authors.initials: PL
authors.lastname: Sanchez
authors.forename: Maximo
authors.initials: M
authors.lastname: Rodriguez-Alemparte
authors.forename: Pedro J
authors.initials: PJ
authors.lastname: Colon-Hernandez
authors.forename: Eugene
authors.initials: E
authors.lastname: Pomerantsev
authors.forename: Ignacio
authors.initials: I
authors.lastname: Inglessis
authors.forename: Nasser A
authors.initials: NA
authors.lastname: Mahdi
authors.forename: Robert C
authors.initials: RC
authors.lastname: Leinbach
authors.forename: Igor F
authors.initials: IF
authors.lastname: Palacios
mesh_terms: D000368:Aged; D017225:Atherectomy, Coronary; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome