Short-term outcome of percutaneous coronary intervention with directional coronary atherectomy followed by drug-coated balloon: a preliminary report

Akihiko Sato,Daiki Yaegashi,Shohei Ichimura,Yasuchika Takeishi,Yuko Matsui,Keiji Sakamoto,Yukio Maruyama,Takeshi Shimizu,Yoshitane Seino,Fumiya Anzai,Hironori Kaneko,Mikihiro Kijima

doi:10.1007/s12928-018-0537-6

Abstract

Directional coronary atherectomy (DCA) is a unique technique used in percutaneous coronary intervention (PCI) which involves the removal of plaque from the coronary artery. Treatment with a drug-coated balloon (DCB) appears to be effective, especially when a predilatation of the lesion is performed appropriately. We hypothesize that the combination therapy of DCA with DCB is an effective strategy in PCI. PCI with DCA followed by DCB was performed for 23 patients from December 2014 to April 2017. All DCA procedures were performed under the guidance of intravascular ultrasound (IVUS) findings and all procedures were successfully performed without incurring major complications such as a coronary perforation. Plaque area (PA) was reduced from 77.3 ± 10.4% at baseline to 50.9 ± 9.2% after DCA and luminal cross-sectional area (CSA) after PCI was enlarged from 3.6 ± 1.8 to 9.3 ± 3.3 mm2. Follow-up coronary angiography (CAG) performed at 6–10 months showed no cases having incurred restenosis. Plaque area at follow-up CAG was 52.0 ± 8.5% and luminal CSA was 9.5 ± 2.1 mm2. There were no cases undergoing target vessel revascularization (TVR) and target lesion revascularization (TLR) during the follow-up periods. PCI with DCA followed by DCB might be an effective strategy for de novo lesions.

Highlights

Percutaneous coronary intervention (PCI) has been evolving with the emergence of new therapeutic devices since the first PCI was performed by Andrea Gruentzig in 1977, resulting in a continuous improvement in the outcome of PCI procedures for coronary heart disease
Patient’s characteristics, lesion characteristics, procedural demographics including acute complications related to the PCI procedure, quantitative coronary angiography (QCA) and intravascular ultrasound (IVUS) (QCU) data, and major adverse cardiac events (MACE) defined as composite events including cardiovascular death, non-fatal myocardial infarction, hospitalization due to unstable angina, target lesion revascularization (TLR) and target vessel revascularization (TVR) were all investigated during follow-up periods
Out of the 40 patients, 23 patients were treated with Directional coronary atherectomy (DCA)–drug-coated balloon (DCB) and follow-up coronary angiography (CAG) was performed for 14 patients

Summary

Introduction

Percutaneous coronary intervention (PCI) has been evolving with the emergence of new therapeutic devices since the first PCI was performed by Andrea Gruentzig in 1977, resulting in a continuous improvement in the outcome of PCI procedures for coronary heart disease. Lesions including left main trunk [8]. After revival of a new DCA catheter, DCA has been performed for suitable coronary lesions such as non-tortuous and non-severe calcified lesions in proximal to middle segment with relatively large vessel diameter and short length (< 20–30 mm), especially bifurcated lesions including the left main trunk (LMT), ostial left anterior descending coronary artery (LAD) and ostial left circumflex coronary artery (LCX). The drug-coated balloon (DCB) is a new device of coronary intervention and the usefulness of DCB in in-stent restenosis, bifurcated lesions and small vessel diseases is well established by several studies and many clinical experiences [9]. Recent studies have reported the clinical efficacy of stentless PCI with DCB for de novo lesions in DES era [10, 11], because PCI using DES leaves metal stents in a body and may cause stent-related adverse events such as stent thrombosis, neoatherosclerosis, metallic allergy and bleeding events associated with an antiplatelet therapy

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