Coronary stenting after rotational atherectomy in diffuse lesions of the small coronary artery: comparison with balloon angioplasty prior to stenting

Abstract

More than 30% of the lesions currently treated size. The patients were randomly assigned to either using interventional approaches are smaller in size coronary stenting after rotational atherectomy (group than established indications for stenting [1]. However I, n521) or balloon angioplasty prior to stenting vessel size is inversely correlated with restenosis rate (group II, n520) according to computer-generated and adverse outcome after percutaneous coronary randomization lists. In group I, single burr was used interventions [2]. Furthermore, the treatment of long with an intended burr-to-artery ratio of 0.6. Adjunclesions with percutaneous interventions has a lower tive balloon dilatation was performed using a nonsuccess rate and a higher restenosis rate than the compliant balloon, a balloon-artery ratio of 1.1:1 was treatment of discrete lesions [3]. It remains controused, with inflation pressures less than nominal for a versial whether stenting is an effective therapy for given balloon (less than 4 atm). For stent placement diffuse small coronary artery disease. in both groups, tubular stents were used in all case. A previous study reported that debulking prior to After rotablation (group I) or pre-dilatation (group stenting with rotational atherectomy improves acute II), the stents were deployed by inflating the stent outcomes in diffuse lesions of small vessels [4]. delivery balloon at a single high pressure ($10 Another study reported that optimal stenting after atmospheres). The primary end-point of the present rotational atherectomy in discrete complex lesions is study was angiographic restenosis at follow-up (deassociated with a low restenosis rate [5]. However, fined as a narrowing of the vessel diameter of the long-term result of rotational atherectomy prior to $50%). The secondary end-points of the study were stenting in diffuse lesions of small coronary arteries adverse clinical events, such as all causes of death, has not been evaluated. myocardial infarction, stroke, and target vessel reWe enrolled 41 patients with symptomatic isvascularization. chemic heart disease scheduled for elective coronary Rotational atherectomy prior to stenting resulted in angioplasty in our study. Inclusion criteria were a a greater acute gain in minimal lumen diameter than long, de novo lesion (lesion length.20 mm, diameter did balloon angioplasty prior to stenting (P,0.05). stenosis.50%) in a native left anterior descending However, later loss was greater in the rotational coronary artery (LAD) between 2 and 2.9 mm in atherectomy group than in the balloon angioplasty group (P,0.05), resulting in similar net gains (Fig. 1). There was no significant difference in angiog*Corresponding author. Tel.: 182-2-361-7049; fax: 182-2-393-2041. E-mail address: cdhlyj@yumc.yonsei.ac.kr (D. Choi). raphic restenosis rate (33.3 vs. 31.3%, P50.80),