Mellat Park, Vali Asr Avenue, Tehran, Iran


Background - When it is impossible to cross and to dilate the lesion, particularly calcified lesions, ostial lesions, bifurcation lesions, long lesions (10-25mm) and when diffuse in-stent restenosis could be considered complex, rotary ablation may be a more effective treatment than Percutaneus Transluminal Coronary Angioplasty (PTCA) in this setting. This study evaluated the clinical safety, immediate and mid-term results of rotational atherectomy (RA) followed by balloon dilatation for the treatment of complex lesions of the coronary arteries.
Methods - Between July 1998 and October 2000, 38 consecutive patients with complex lesions were treated with RA. Seventy six percent of the lesions were calcified, 21% were ostial, 16% of the lesions were un-crossable and 21% of the patients had diffuse in-stent restenosis. Fifty percent of the patients underwent angiography and all of them underwent exercise thallium scanning at six months’ follow-up.
Results - Procedural success was achieved in 97% of the cases. Creatine kinase MB enzyme elevation occurred in 5.3%. Minimum luminal diameter (MLD) increased from 0.55± 0.25mm to 1.9±0.41mm after RA and to 2.65±0.35mm after adjunct PTCA. The mean burr to artery ratio was 0.69±0.16 and the mean balloon to artery ratio was 1.1±0.1 and balloon dilatation was performed at 12±2atm. There was neither Q-wave myocardial infarction nor death at a mean follow up of 11±3 months. Restenosis occurred in 21% of the patients with target vessel revascularization (TVR) of 16%.
Conclusion: Coronary rotational atherectomy is a safe and feasible technique and is associated with a high success rate and a relatively low restenosis rate in the treatment of complex undilatable lesions.