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ROTATIONAL ATHERECTOMY: A BETTER MOUSETRAP?

In the relentless search for a method of coronary angioplasty that has better outcomes than balloon dilatation, several new technologies have been tested and found wanting. This report describes 709 consecutive patients who underwent rotational atherectomy, which opens stenoses with a flexible diamond-coated "drill bit". Because the pieces of debris are small, they are not removed from the coronary circulation.

The patients had coronary anatomy that made them poor candidates for balloon angioplasty, and their lesions were described as eccentric (61 percent), calcified (32 percent), tortuous (27 percent) and long (25 percent). Nevertheless, the overall success rate of rotational atherectomy was 95 percent, and only 3 percent of patients had major procedure- related complications (death, myocardial infarction, and emergent bypass surgery).

At six-month follow-up, the restenosis rate was 38 percent -- comparable to that of other angioplasty technologies. Restenosis was more common in patients with diabetes (56 vs. 34 percent).

Comment: Rotational atherectomy seems a safe and effective method for treating coronary atherosclerosis that might not respond well to balloon angioplasty, but its superiority over balloon angioplasty for routine cases remains unproven. (The equipment manufacturer funded this study.)

— TH Lee

Published in Journal Watch General Medicine September 27, 1994

Citation(s):

Warth DC et al. Rotational atherectomy multicenter registry: acute results, complications, and 6-month angiographic follow-up in 709 patients. J Am Coll Cardiol 1994 Sep 24 641-648.

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