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GOOD OUTCOMES AFTER CORONARY ATHERECTOMY.

Directional coronary atherectomy involves excision of atherosclerotic tissue to enlarge the lumen of stenotic coronary arteries. To evaluate the role of this new procedure, investigators collected follow-up data on 190 patients who underwent a total of 225 atherectomies at Boston's Beth Israel Hospital between 1988 and 1991.

Ninety-seven percent of the lesions had been considered unfavorable for balloon angioplasty because of eccentric configuration, ostial location, or calcification. Nevertheless, atherectomy was successful in 91 percent of all lesions. Balloon angioplasty was performed successfully in another 7 percent of lesions after atherectomy failed. There were no deaths or Q-wave myocardial infarctions, and only one patient had emergency bypass surgery. Repeat angiography at 6 months, performed in 77 percent of patients, revealed a restenosis rate of 32 percent. Restenosis rates were lower in patients with cholesterol levels below 200 mg/dl, recent MI, or larger post-procedure lumens. Mortality was 2 percent at 1 year, and rose to 5 percent annually during the next 2 years.

These data provide encouraging evidence that coronary atherectomy is a useful technique, especially for lesions that do not lend themselves to balloon dilatation.

— THL

Published in Journal Watch General Medicine November 10, 1992

Citation(s):

Fishman RF et al. Long-term results of directional coronary atherectomy: predictors of restenosis. J Am Coll Cardiol 1992 Nov 1 20 1101-1110.

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