Treatment of complex and "undilatable" coronary stenosis using rotational atherectomy with adjunctive or complementary balloon angioplasty

Abstract

We studied 32 patients who had complex lesions or morphologic characteristics associated with poor outcome utilizing conventional PTCA, such as ostial stenosis, calcified lesions, long or diffuse lesions, restenotic lesions or Lesions which can not be crossed or dilnted with a balloon. These 32 patients underwent 72 procedures in which rotational atherectomy and adjuncrive or complementary PTCAwereperformedin 33 vessels to treat 50lesions. Theywere mainly (87.5Vo) in the left anteriordescendiig coronary artery' According to modffied ACC/AHA lesion classification, there were 19 type B2 lesions (38.0Vo) and 3l type C lesiois (62.0Vo). Plain balloon angioplasty was also performed in additional 22 lesions .Of the 32 patients, 19 were mnle and 13 femate. Their ages ranged from 42 to 79 years. The majority presented with Canadian Cardiovasculai Society angina class III or IV. The left ventricular eiectionfractionwas 507o in 17 pati.ents (53.1 Eo), 30 - 50% in l0 patients (31.3Vo) and 3dVo in 5 patients (I5.6qo). In 3 patients rotational atherectomy was performedwith the aid of intra-aortic balloon pumping for hemodynamic stabi1zation. single vessel disease was Present in 7 patients (21.9Vo), double vessel disease in 19 patients (59.4Vo) and triple vessel disease in 6 patients (lg.77o). Angiographic and procedural success rates were l00Vo. However, largely, success criteriawas achieved after adjunctive or complementary PTCA had been performed. Complex and undilatable coronary stenosis may be treated with rotational atherectomy and adjunctive or complementary PTCA.