Clinical Studies
Rotational atherectomy for in-stent restenosis: acute and long-term results of the first 100 cases

This work was presented in part at the XIXth Congress of the European Society of Cardiology, Stockholm, Sweden, August 1997, and at the 70th American Heart Association Meeting, Orlando, Florida, November 1997.
https://doi.org/10.1016/S0735-1097(98)00382-9Get rights and content
Under an Elsevier user license
open archive

Abstract

Objectives. This study evaluated the clinical safety and long-term results of rotational atherectomy (RA) followed by low-pressure balloon dilatation (percutaneous transluminal coronary angioplasty [PTCA]) for the treatment of in-stent restenosis (ISR).

Background. In-stent restenosis is associated with a high incidence of recurrence after interventional treatment. Because ISR is due to neointimal hyperplasia, rotational ablation may be a more effective treatment than PTCA.

Methods. Between November 1995 and November 1996, 100 consecutive patients with first-time ISR were treated by RA. Quantitative coronary angiography and intravascular ultrasound (IVUS) were used to analyze the acute procedural results. The incidence of repeat in-stent restenosis and target vessel revascularization (TVR) at follow-up was determined.

Results. Procedural success without any major in-hospital complications was achieved in 100% of cases. Slow flow was observed in 3% and creatine kinase-MB enzyme elevation >3× normal occurred in 2%. The mean burr-to-artery ratio was 0.68 ± 0.18 and adjuvant balloon dilatation was performed at 4.2 ± 2.1 atm. Minimum luminal diameter increased from 0.86 ± 0.28 mm to 1.89 ± 0.21 mm after RA and to 2.56 ± 0.29 mm after adjunct PTCA. Quantitative IVUS analysis showed that 77% of the luminal gain occurred due to rotational ablation of the restenotic tissue and only 23% occurred after adjunct balloon dilation, and further stent expansion did not contribute to the luminal enlargement. At a mean follow-up of 13 ± 5 months, repeat in-stent restenosis occurred in 28% of patients with TVR of 26%. Univariate predictors of repeat restenosis were burr-to-artery ratio <0.6, ISR in <90 days of stenting, ostial lesion, stent for a restenotic lesion and diffuse type ISR.

Conclusions. Rotational atherectomy is a safe and feasible technique for treatment of ISR and is associated with a relatively low recurrent restenosis in comparison to historical controls of balloon angioplasty.

Abbreviations

CABG
coronary artery bypass surgery
CSA
cross-sectional area
IH
intimal hyperplasia
ISR
in-stent restenosis
IVUS
intravascular ultrasound
PTCA
percutaneous transluminal coronary angioplasty
QCA
quantitative coronary analysis
RA
rotational atherectomy
TVR
target vessel revascularization

Cited by (0)

There is no financial industry support for this study.