These tools will no longer be maintained as of December 31, 2024. Archived website can be found here. PubMed4Hh GitHub repository can be found here. Contact NLM Customer Service if you have questions.


Pubmed for Handhelds

PUBMED FOR HANDHELDS

Search MEDLINE/PubMed

  • Title: High speed rotational atherectomy for diffuse in-stent restenosis: short- and mid-term follow-up results.
    Author: Gambhir DS, Singh S, Sinha SC, Kaul UA, Arora R.
    Journal: Indian Heart J; 1999; 51(1):41-6. PubMed ID: 10327778.
    Abstract:
    Between January 1997 to May 1998, 37 consecutive patients underwent high speed rotational atherectomy with adjunctive balloon angioplasty for the management of first-time diffuse variety of in-stent restenosis in the native coronary arteries. Their age ranged from 38 to 71 years (mean 54.3 +/- 9.7 years). All the patients underwent initial stent implantation at moderate to high pressure. Patients were either symptomatic or demonstrated significant ischaemia by non-invasive testing. The median time from the index procedure to in-stent restenosis was 20 weeks (range 9-40 weeks). Majority (78.1%) of lesions were in the territory of left anterior descending coronary artery. The mean lesion length was 24.3 +/- 8.3 mm (range 12-42 mm). Five lesions each (12.2%) were total occlusion and ostial in location. High speed rotational atherectomy was performed using stepped burr technique in majority (90.2%) with the largest burr corresponding to approximately 70 percent of the reference vessel diameter. The initial burr size ranged from 1.5-2.0 mm, final burr was 1.75-2.25 mm and the average number of burrs used per target vessel was 2.2 +/- 0.3 (range 1-3). Adjunctive balloon angioplasty was performed in all (100%) cases using a semi-compliant oversized balloon (balloon-to-artery ratio 1.1:1) inflated at a pressure of 6.5 +/- 2.1 atmospheres (range 4-10). The procedure was successful in all cases without any major complications (death, Q-MI, CABG or repeat PTCA). Over a median follow-up of 10 months, 27 (73%) patients were asymptomatic. Recurrence of clinical events occurred in 10 (27%) patients at median interval of 16 weeks after rotational atherectomy. Angina was controlled on drug therapy in six (16.2%) and target vessel revascularisation was required in three (8.1%) cases. By the Kaplan-Meier estimate, an event-free survival (absence of death, Q-MI, recurrence of angina, target vessel revascularisation) was 97.3, 94.6, 75.7 and 72.6 percent at 1, 3, 6 and 12 months, respectively. Thus, rotational atherectomy using a stepped burr approach for adequate debulking, followed by adjunctive balloon angioplasty is safe with excellent in-hospital results for the treatment of diffuse in-stent restenosis. Although recurrence of symptoms develops in approximately one-fourth of patients on follow-up, it is much less than reported with balloon angioplasty in this subgroup of patients.
    [Abstract] [Full Text] [Related] [New Search]