title: Long-term outcomes of plaque debulking with rotational atherectomy in side-branch ostial lesions to treat bifurcation coronary disease.
abstract: BACKGROUND
  The prognosis after rotational atherectomy of a side-branch ostium to treat bifurcation coronary lesions is unknown.
  
  
  METHODS
  This was a retrospective case-review study of 40 consecutive patients who underwent rotational atherectomy of the sidebranch ostium to treat symptomatic bifurcation coronary lesions meeting the Medina classification (1,1,1) at our institution between 2003 and 2007.
  
  
  RESULTS
  Twenty-two (55.0%) patients underwent rotational atherectomy of the side-branch ostium alone and 18 (45.0%) underwent rotational atherectomy of the both the main vessel and the sidebranch ostium. Most of the patients (n = 37, 92.5%) had a drug-eluting stent placed in the main vessel after rotational atherectomy. Only 8 patients (20.0%) required side-branch stents, and 2 patients (5.0%) underwent a final kissing-balloon technique. No acute closure of the side branch or coronary perforation were observed. Major adverse cardiac events included cardiac death (n = 1; 2.5%), nonfatal myocardial infarction (n = 1; 2.5%), target vessel revascularization (n = 2; 5.0%) and target lesion revascularization (n = 0; 0.0%) during the mean follow-up period of 21.3 +/- 18.5 months.
  
  
  CONCLUSIONS
  The study demonstrated safety and feasibility of rotational atherectomy and provisional side-branch stenting to treat side-branch ostial lesions of true severe bifurcation coronary artery disease. The study results suggest that rotational atherectomy of a side-branch ostium prior to main-vessel stenting may be an option in selected patients undergoing complex bifurcation lesion angioplasty.
authors.affiliation: Division of Cardiology, Loyola University Medical Center, EMS Building 6th Floor, 2160 S. First Avenue, Maywood, IL 60153, USA. itohiroki@gmail.com
authors.forename: Hiroki
authors.initials: H
authors.lastname: Ito
authors.forename: Sheri
authors.initials: S
authors.lastname: Piel
authors.forename: Pranab
authors.initials: P
authors.lastname: Das
authors.forename: Vikram
authors.initials: V
authors.lastname: Chhokar
authors.forename: Ghazanfar
authors.initials: G
authors.lastname: Khadim
authors.forename: Robert
authors.initials: R
authors.lastname: Nierzwicki
authors.forename: Alexis
authors.initials: A
authors.lastname: Williams
authors.forename: Robert S
authors.initials: RS
authors.lastname: Dieter
authors.forename: Fred
authors.initials: F
authors.lastname: Leya
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods* / Q000401:mortality; D017225:Atherectomy, Coronary / Q000379:methods* / Q000401:mortality; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D003331:Coronary Vessels; D054855:Drug-Eluting Stents; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome