Long-term outcome of patients with proximal left anterior descending coronary artery in-stent restenosis treated with rotational atherectomy

Citation
R. Moreno et al., Long-term outcome of patients with proximal left anterior descending coronary artery in-stent restenosis treated with rotational atherectomy, CATHET C IN, 52(4), 2001, pp. 435-442
Citations number
25
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Cardiovascular & Respiratory Systems
Journal title
CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS
ISSN journal
1522-1946 → ACNP
Volume
52
Issue
4
Year of publication
2001
Pages
435 - 442
Database
ISI
SICI code
1522-1946(200104)52:4<435:LOOPWP>2.0.ZU;2-Q
Abstract
Once a first interventional procedure has failed, patients with proximal le ft anterior descending in-stent restenosis are frequently sent for surgical revascularization. Data on long-term outcome in selected patients with pro ximal left anterior descending in-stent restenosis treated with RA are lack ing. The study's objective was to evaluate the longterm outcome of patients with proximal left anterior descending artery in-stent restenosis treated with rotational atherectomy. The study population is constituted by 42 pati ents with proximal left anterior descending in-stent restenosis treated wit h rotational atherectomy. Patients were followed up for 2.1 +/- 0.9 years ( range, 6-54), Restenosis length was 16.5 +/- 9.2 mm, and restenosis was dif fuse (> 10 mm in length) in 30 (71,4%). The rotational atherectomy procedur e was guided by intravascular ultrasound in 18 patients (42.9%). Maximum bu rr/artery ratio was > 0.7 in 24 (57.1%) patients. One patient suffered a pe riprocedural non-Q-wave infarction, but no deaths, Q-wave infarction, or ne w target vessel revascularization occurred during hospitalization. There we re no deaths or myocardial infarctions after discharge. Sixteen patients (3 8.1%) needed a new revascularization, but only five (11.9%) underwent coron ary bypass grafting at the end of the follow-up (2.1 +/- 0.9 years). The ra te of surgical revascularization at 6 months, 1 year, and 3 years was 4.8%, 7.4%, and 18.4%, respectively. The rate of new target vessel revasculariza tion at 6 months, 1 year, and 3 years was 16.7%, 36.5%, and 40.5%, respecti vely. Patients with less than or equal to 5 months since stent implantation had a significantly higher rate of new target vessel revascularization. Pa tients with proximal left anterior descending in-stent restenosis may be sa fely treated with rotational atherectomy, This strategy is associated with a very good long-term outcome, with few patients undergoing surgical revasc ularization. (C) 2001 Wiley-Liss, Inc.