Impact of restenosis after optimal directional coronary atherectomy on regional left ventricular function

Abstract

To assess the effect of optimal directional coronary atherectomy (DCA) on restenosis and left ventricular (LV) function, 95 patients who underwent DCA and adjunctive balloon angioplasty for de novo lesions were prospectively followed for 6 months. Absolute and relative coronary lumen measurements were analyzed with online quantitative coronary angiography. LV volumes, ejection fraction, and segmental wall motion were measured off-line according to the radial method for LV cineangiograms acquired in a right anterior oblique projection. Target vessels were the left anterior descending artery in 63 patients and right coronary artery in 32. Mean (± SD) reference diameter was 3.58 ± 0.65 mm. Mean lumen diameter improved significantly after DCA from 1.19 ± 0.44 to 3.03 ± 0.45 mm, yielding a 14 ± 10% residual stenosis. Overall angiographic restenosis rate (>50% stenosis in diameter) at control was 23%. In patients without restenosis, there were no significant changes in LV volumes or in LV pressures. In this subgroup, ejection fraction improved significantly in the left anterior descending group (mean difference 3 ± 10%, p < 0.04). Moreover, there was an increase in fractional shortening of all anterior segments (mean difference 11 ± 16%, p < 0.005). Improvement in fractional shortening was less marked in the right coronary artery group even without restenosis. We conclude that: (1) optimal DCA can achieve a low restenosis rate in selected large vessels, (2) long-term beneficial effects on regional LV function are possible, particularly in patients with left anterior descending disease and in the absence of coronary restenosis.