Directional coronary atherectomy for the treatment of Palmaz-Schatz in-stent restenosis

Mahdi, Nasser A; Pathan, Asad; Harrell, Lari; Leon, Miltiadis N; López, Julio; Butte, Anjum; Ferrell, Margaret; Gold, Herman K.; Palacios, Igor F.

doi:10.1016/s0002-9149(98)00639-0

Cited by 62 publications

(29 citation statements)

References 25 publications

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“…The importance of achieving maximal lumen size was illustrated by the significant difference in event-free survival of patients with more vs less than 4·7 mm 2 in the final lumen cross-sectional area. These findings are in agreement with other reports where the lumen size, expressed by the angiographic mean lumen diameter, was also a predictor of a clinical event [8,9,13] or recurrent restenosis [16] . Conversely, these findings may not be valid in cases of second stent placement, even if a larger lumen size is achieved [12] .…”

Section: Predictors Of Event-free Survivalsupporting

confidence: 93%

“…Definitions of these events were the same as those used in previous studies with clinical follow-up after repeat intervention [4][5][6][7][8][9]11,13] .…”

Section: Event-free Survival After In-stent Restenosis 755mentioning

confidence: 99%

“…In addition, favourable late clinical outcome has also been shown after repeat balloon angioplasty in such lesions, with an event rate at 1 year ranging between 8 and 17% [5,6] . Conversely, for non-selected in-stent restenotic lesions, including long (>10 mm) lesions, repeat balloon angioplasty has been shown to result in a high incidence of angiographic restenosis [4,5] or clinical events [3,6,7] , thus prompting the use of alternative therapeutic options like debulking prior to balloon angioplasty, with laser, rotational or directional atherectomy [7][8][9][10][11] . To date, no technique has been shown to be superior.…”

Section: Introductionmentioning

confidence: 99%

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Predictors of event-free survival after repeat intracoronary procedure for in-stent restenosis. Study with angiographic and intravascular ultrasound imaging

Schiele

Méneveau

Seronde

et al. 2000

European Heart Journal

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Aims Lumen enlargement during repeat percutaneous coronary intervention for in-stent restenosis has been shown to be the result of both stent over-expansion and decrease in neointimal tissue. How these two different mechanisms of action may influence outcome and target lesion revascularization after repeat intervention for in-stent restenosis is unclear.Methods Intravascular ultrasound guided repeat intervention for in-stent restenosis was carried out either with balloon angioplasty, or with a combination of rotational atherectomy plus balloon angioplasty. Clinical follow-up at 1 year, including death, myocardial infarction, or need for revascularization, was obtained.Results Seventy patients were included in this study; 40 were treated by balloon alone, and 30 by combination of rotational atherectomy plus balloon. Event-free survival probability was 76 5%. The mechanism of lumen enlargement, be it stent over-expansion or tissue removal, had no influence on long-term clinical evolution. The only independent predictor was the minimal lumen crosssectional area at the end of the procedure, the larger the lumen cross-sectional area, the higher the event-free probability. The cut-off point of the lumen cross-sectional area was set at 4·7 mm 2 by discriminant analysis. Event-free survival was 69 15% in patients with <4·7 mm 2 lumen cross-sectional area and 91 8% in patients with >4·7 mm 2 lumen cross-sectional area (P=0·008).Conclusions This study showed that the only independent predictor of late clinical outcome after percutaneous re-intervention for in-stent restenosis was final lumen size, no matter which means were used to achieve it.

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Section: Predictors Of Event-free Survivalsupporting

confidence: 93%

“…Definitions of these events were the same as those used in previous studies with clinical follow-up after repeat intervention [4][5][6][7][8][9]11,13] .…”

Section: Event-free Survival After In-stent Restenosis 755mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Predictors of event-free survival after repeat intracoronary procedure for in-stent restenosis. Study with angiographic and intravascular ultrasound imaging

Schiele

Méneveau

Seronde

et al. 2000

European Heart Journal

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“…Plaque removal with directional atherectomy facilitates treatment of ostial [1] and bifurcation lesions [2,3] and allows effective debulking of intimal hyperplasia for in-stent restenosis [4,5]. Controlled prospective registries have also suggested that atherectomy prior to stenting can facilitate stent expansion and reduce late hyperplasia [6 -9].…”

Section: Introductionmentioning

confidence: 99%

Effective plaque removal with a new 8 French‐compatible atherectomy catheter

Takagi

Mario

Stanković

et al. 2002

Cathet Cardio Intervent

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The purpose of this study was to evaluate the safety and efficacy of the new 8 Fr guide catheter-compatible Flexicut directional atherectomy device and to compare it with the conventional Atherocath GTO catheter. The 6 Fr Flexicut catheter has a larger cutting window and a titanium nitride-coated cutter to effect more tissue removal as well as treat mildly calcified lesions. A group of 143 lesions in 117 consecutive patients treated with the Flexicut catheter in four centers were compared with a control group of 277 lesions in 212 consecutive patients treated with the GTO device. Postatherectomy luminal diameters were larger (2.92 +/- 0.79 vs. 2.52 +/- 0.64 mm; P < 0.0001), with more luminal gain (relative gain: 0.58 +/- 0.24 vs. 0.48 +/- 0.25; P = 0.0007) using fewer directional coronary atherectomy (DCA) cuts (12 +/- 7 vs. 16 +/- 9; P = 0.0001) in the Flexicut group. A residual diameter stenosis < 20% immediately after DCA was obtained in 77% of the lesions in the Flexicut group vs. 45% in the GTO group (P < 0.0001). Histology in the former group revealed large calcium speckles in the retrieved specimens. In the Flexicut group, there was a lower incidence of access site complications and damage to the coronary ostium (2.5% vs. 7.5%; P = 0.08). The new Flexicut catheter is more effective than the conventional GTO catheter with a trend for reduced guiding catheter-related complications.

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“…Balloon dilation [1,2], laser ablation [3], rotational ablation [4,5], directional atherectomy [6], and restenting [7] all are used; brachytherapy is currently in trial. Despite access to all of these devices, stent restenosis nonetheless is difficult to manage, particularly when a diffuse pattern of in-stent tissue proliferation appears, and often ultimately requires coronary bypass.…”

mentioning

confidence: 99%