Balloon postdilation can safely improve the results of successful (but suboptimal) directional coronary atherectomy

Abstract

This study investigates whether adjunctive balloon angioplasty can be safely used to improve acute results in cases where directional coronary atherectomy alone has provided a successful (but suboptimal) outcome. Between October 1, 1990, and October 1, 1992, directional coronary atherectomy was performed successfully in 198 of 228 lesions. Individual operators believed that most acute results were satisfactory after atherectomy alone (group 1, n = 115) with a minimal lumen diameter that increased from 0.82 ± 0.45 to 3.21 ± 0.65 mm after atherectomy, for an acute gain in lumen diameter of 2.39 ± 0.73 mm and a residual stenosis of 6 ± 13%. In 42% of lesions (group II, n = 83), however, results were considered suboptimal after atherectomy alone, with a minimal lumen diameter that increased from 0.85 ± 0.45 to 2.83 ± 0.64 mm, a smaller acute gain of 1.96 ± 0.72 mm, and a mean residual stenosis of 17 ± 14% (although all residual stenoses were < 50%,19% had a residual stenosis >30%). Adjunctive balloon angioplasty in these group 11 lesions provided an additional gain of 0.34 ± 0.38 mm, bringing the total acute gain for group II lesions to 2.32 ± 0.78 mm and the residual stenosis to 9 ± 13%, similar to that of group I patients who underwent atherectomy alone. This strategy resulted in a 7 ± 13% overall residual stenosis for the study population, with no higher incidence of periprocedural complications or adverse late clinical outcomes in group II patients. Thus, adjunctive balloon angioplasty following directional coronary atherectomy can be used effectively to optimize postprocedural lumen diameter without adversely affecting either immediate safety or late clinical outcome.