title: Treatment of stent-jailed side branch stenoses with rotational atherectomy.
abstract: While debulking with rotational atherectomy (RA) prior to balloon angioplasty (BA) improves acute results by reducing elastic recoil, treatment of an ostial side branch lesion that is covered (jailed) by a stent represents a particular challenge. We report our experience with RA in conjunction with BA for the treatment of ostial stenosis in jailed side branches.
  
  
  RESULTS
  Thirty-two lesions in side branches jailed by a stent were treated with RA and BA 39 times in 30 patients. The mean age was 65.5 +/- 11.5 years; 26.3% were women; 18.4% had diabetes mellitus; and 18.4% had a history of prior bypass surgery. Of the treated side branches, 53.9% were diagonals, 71.8% were jailed by a slotted-tube stent, and 86.5% were previously dilated prior to RA. The burr sizes used to treat the jailed side branch origin ranged from 1.25 to 2.25 mm, with a mean burr size of 1.62 +/- 0.31 mm. An average of 1.53 +/- 0.72 burrs were used per lesion. Quantitative coronary angiography was performed prior to, and after, intervention. The mean diameter stenosis of the side branch prior to revascularization was 77.8% +/- 12.6%; this was reduced to a mean stenosis of 23.0% +/- 17.9% following treatment with RA and BA. Angiographic success (residual stenosis < 50% and TIMI 3 flow) in the side branch occurred in 36 of 39 lesions (92.3%). Procedural success (angiographic success in both the side branch and the parent vessel in the absence of death, emergent CABG, urgent TVR, and myocardial infarction (CK-MB > or = 3 times normal) during the index hospitalization) was achieved in 33 of 38 cases (86.8%). One patient suffered a periprocedural myocardial infarction; another patient presented with stent thrombosis in the parent vessel requiring emergency revascularization 36 hours after the index procedure. Clinically-driven revascularization of either the side branch or the side branch or parent was performed in 44.8% and 46.4% of patients, respectively. The estimated freedom from any target lesion revascularization was 47.7% at 300 days. One patient died of unknown causes 253 days following the index procedure.
  
  
  CONCLUSIONS
  RA in conjunction with BA can effectively treat stent-jailed ostial side branch stenosis with excellent acute angiographic and procedural results. However, the long-term efficacy is limited by a high rate of repeat revascularization.
authors.affiliation: Cardiovascular Associates, Sutter Pacific Heart Centers, Larkspur, California, USA.
authors.forename: Robert T
authors.initials: RT
authors.lastname: Sperling
authors.forename: Kalon
authors.initials: K
authors.lastname: Ho
authors.forename: David
authors.initials: D
authors.lastname: James
authors.forename: Roger
authors.initials: R
authors.lastname: Laham
authors.forename: Michael
authors.initials: M
authors.lastname: Gibson
authors.forename: Joseph
authors.initials: J
authors.lastname: Carrozza
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D017225:Atherectomy, Coronary; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015607:Stents; D016896:Treatment Outcome