Objectives.: The purpose of this study was to describe the results of transluminal extraction coronary atherectomy in native coronary arteries. Background.: Transluminal extraction coronary atherectomy was approved by the Food and Drug Administration for use in native coronary arteries and vein grafts. Methods.: Between December 1988 and July 1992, transluminal extraction coronary atherectomy was performed in 181 native coronary arteries in 175 patients. A detailed angiographic and clinical assessment was performed. Results.: Quantitative angiography (mean ± SD) revealed an increase in minimal lumen diameter from 1.0 ± 0.6 mm before to 1.3 ± 0.7 mm after atherectomy, to 2.1 ± 0.8 mm after final treatment (p < 0.001), corresponding to a diameter stenosis of 70 ± 16%, 61 ± 21% and 36 ± 21%, respectively (p < 0.001). Final procedural success (final diameter stenosis <50%, no major complications) was achieved in 84%. Adjunctive angioplasty was used after atherectomy in 152 lesions (84%) to further enlarge lumen dimensions (130 lesions, 72%), salvage technical failures (2 lesions, 1%) and reverse atherectomy-induced abrupt closures (20 lesions, 11%). Clinical complications included death (2.3%), Q wave myocardial infarction (3.4%) and emergency bypass surgery (2.8%). The strongest independent correlate of major clinical complications was development of abrupt closure immediately after atherectomy (p = 0.01). Clinical follow-up of 92% of eligible patients revealed clinical restenosis (repeat intervention, late bypass surgery, myocardial infarction or death) in 28.5%. Angiographic follow-up of 83% of eligible lesions revealed a restenosis rate (diameter stenosis >50%) of 61%. Conclusions.: Transluminal extraction coronary atherectomy is limited by a modest degree of lumen enlargement, frequent need for adjunctive angioplasty and a high restenosis rate. For complex lesions in native coronary arteries, transluminal extraction coronary atherectomy appears to offer no advantage over conventional balloon angioplasty.
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine