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. 1992 Sep;20(3):623-32.
doi: 10.1016/0735-1097(92)90017-h.

Restenosis after directional coronary atherectomy

T Hinohara  1 , G C Robertson, M R Selmon, J W Vetter, M H Rowe, L J Braden, B J McAuley, D J Sheehan, J B Simpson
Affiliations
Free article

Restenosis after directional coronary atherectomy

T Hinohara et al. J Am Coll Cardiol. 1992 Sep.
Free article

Abstract

Objectives: This study evaluates the incidence of restenosis after successful directional coronary atherectomy and identifies risk factors for restenosis.

Background: Directional coronary atherectomy has been shown to be a safe and effective treatment of obstructive coronary artery disease; however, information regarding restenosis is limited.

Methods: Between October 1986 and December 1989, 289 patients with 332 lesions were successfully treated with directional coronary atherectomy and followed up prospectively. Clinical follow-up information was available for 98% and angiographic follow-up information was obtained for 82% at approximately 6 months, or earlier if symptoms recurred. Angiograms were quantitatively analyzed. Restenosis was defined as greater than 50% stenosis at the site of intervention.

Results: Seventy-four percent of patients were either asymptomatic or clinically improved after the procedure. Thirty-two percent were subsequently treated by coronary artery bypass surgery (14%), percutaneous transluminal coronary angioplasty (4%) or repeat atherectomy (13%). Angiographic evidence of restenosis was observed in 42%. The restenosis rate in native coronary arteries was 31% for primary lesions and 28% and 49%, respectively, for lesions treated with one or two previous angioplasty procedures. The restenosis rate for saphenous vein grafts was 53% for primary lesions and 58% and 82%, respectively, for lesions treated with one or two previous angioplasty procedures. The median interval to angiographically documented restenosis was 133 days. A higher restenosis rate was associated with a saphenous vein graft, hypertension, a longer lesion (greater than or equal to 10 mm), a smaller vessel diameter (less than 3 mm), a noncalcified lesion and use of a smaller (6F) device.

Conclusions: Restenosis remains a limitation of directional coronary atherectomy. A subset of patients with larger vessels, shorter lesions or lesions treated with a larger (7F) device may have a more favorable outcome.

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