‘Optimal’ Directional Coronary Atherectomy

Simonton, Charles A.; Leon, Martin B.; Baim, Donald S.; Hinohara, Tomoaki; Kent, Kenneth M.; Bersin, Robert M.; Wilson, Bivin; Mintz, Gary S.; Fitzgerald, Peter J.; Yock, Paul G.; Popma, Jeffery J.; Ho, Kalon K.L.; Cutlip, Donald E.; Senerchia, Cynthia; Kuntz, Richard E.

doi:10.1161/01.cir.97.4.332

Cited by 125 publications

(26 citation statements)

References 14 publications

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“…25 The MLD after the procedure was 2.81 mm in this trial and 2.82 mm in BOAT; in the subgroup of patients with "optimal atherectomy," the MLD after the procedure was 3.09 mm in this trial compared with 3.16 mm in the Optimal Atherectomy Restenosis Study (OARS). 26 The late loss (0.81 mm) in EUROCARE was substantially less than that in both BOAT (0.96 mm) and OARS (1.18 mm), so the restenosis rate in EUROCARE is also lower (23.6%) than that in BOAT (31.4%) and OARS (28.9%). The incidence of target lesion revascularization in EUROCARE (17.1%) was slightly lower than that in BOAT (21.1%) and similar to that in OARS (17.8%).…”

Section: Comparison Of Atherectomy Results With Other Trialsmentioning

confidence: 93%

Carvedilol for Prevention of Restenosis After Directional Coronary Atherectomy

et al. 2000

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on behalf of the EUROCARE study groupBackground-In addition to its known properties as a competitive, nonselective ␤ and ␣-1 receptor blocker, carvedilol directly inhibits vascular myocyte migration and proliferation and exerts antioxidant effects that are considerably greater than those of vitamin E or probucol. This provides the basis for an evaluation of carvedilol for the prevention of coronary restenosis. Methods and Results-In a prospective, double-blind, randomized, placebo-controlled trial, 25 mg of carvedilol was given twice daily, starting 24 hours before scheduled directional coronary atherectomy and continuing for 5 months after a successful procedure. The primary end point was the minimal luminal diameter as determined during follow-up angiography 26Ϯ2 weeks after the procedure. Of 406 randomized patients, 377 underwent attempted atherectomy, and in 324 (88.9%), a Յ50% diameter stenosis was achieved without the use of a stent. Evaluable follow-up angiography was available in 292 eligible patients (90%). No differences in minimal luminal diameter (1.99Ϯ0.73 mm versus 2.00Ϯ0.74 mm), angiographic restenosis rate (23.4% versus 23.9%), target lesion revascularization (16.2 versus 14.5), or event-free survival (79.2% versus 79.7%) between the placebo and carvedilol groups were observed at 7 months. Conclusions-The maximum recommended daily dose of the antioxidant and ␤-blocker carvedilol failed to reduce restenosis after successful atherectomy. These findings are in contrast to those of the Multivitamins and Probucol Trial, which raises doubts regarding the validity of the interpretation that restenosis reduction by probucol was via antioxidant effects. The relationship between antioxidant agents and restenosis remains to be elucidated. (Circulation.

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Section: Comparison Of Atherectomy Results With Other Trialsmentioning

confidence: 93%

Carvedilol for Prevention of Restenosis After Directional Coronary Atherectomy

et al. 2000

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“…[11][12][13] Because patients with renal failure have a higher incidence of complex coronary lesion morphology, which is less amenable to conventional balloon angioplasty, 8 these new devices may offer hope to this population. In our study, percuta- neous interventional methods changed considerably during the period of observation.…”

Section: Discussionmentioning

confidence: 99%

“…8 Over the last decade, new lesion-specific coronary devices, such as coronary stents and a variety of debulking techniques, have improved the outcome of PCI in complex lesions. [9][10][11][12][13] Therefore, the present study was designed to determine the immediate and long-term outcomes of patients with varying degrees of renal failure in the current new device era.…”

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confidence: 99%

Are Patients With Renal Failure Good Candidates for Percutaneous Coronary Revascularization in the New Device Era?

et al. 2000

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Background-Patients with end-stage renal disease undergoing conventional balloon angioplasty have reduced procedural success and increased complication rates. This study was designed to determine the immediate and long-term outcomes of patients with varying degrees of renal failure undergoing percutaneous coronary intervention in the current device era. Methods and Results-We compared the immediate and long-term outcomes of 362 renal failure patients (creatinine Ͼ1.5 mg/dL) with those of 2972 patients with normal renal function who underwent percutaneous coronary intervention between 1994 and 1997. Patients with renal failure were older and had more associated comorbidities. They had reduced procedural success (89.5% versus 92.9%, Pϭ0.007) and greater in-hospital combined major event (death, Q-wave myocardial infarction, emergent CABG; 10.8% versus 1.8%; PϽ0.0001) rates. Renal failure was an independent predictor of major adverse cardiac events (MACEs) (OR, 3.41; 95% CI, 1.84 to 6.22; PϽ0.00001). Logistic regression analysis identified shock, peripheral vascular disease, balloon angioplasty strategy, and unstable angina as independent predictors of in-hospital MACEs in the renal group. Compared with 362 age-and sex-matched patients selected from the control group, patients with renal failure had a lower survival rate (27.7% versus 6.1%, PϽ0.0001) and a greater MACE rate (51% versus 33%, PϽ0.001) at long-term follow-up. Cox regression analysis identified age and PTCA strategy as independent predictors of long-term MACEs in the renal group. Finally, within the renal failure population, the dialysis and nondialysis patients experienced remarkably similar immediate and long-term outcomes. Conclusions-Although patients with renal failure can be treated with a high procedural success rate in the new device era, they have an increased rate of major events both in hospital and at long-term follow-up. Nevertheless, utilization of stenting and debulking techniques improves immediate and long-term outcomes. (Circulation. 2000;102:2966-2972.)

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“…1 Directional atherectomy may have advantages for treating ostial lesions; however, it may not provide a significant impact on the restenosis because it cannot completely eliminate acute recoil and arterial remodeling. 10,11 Coronary stenting is effective in minimizing recoil and reducing restenosis, but in-stent restenosis for ostial lesions still remains a problem. 12 The CB is a unique angioplasty device used in percutaneous coronary interventions.…”

Section: Discussionmentioning

confidence: 99%

Long‐Term Clinical Efficacy of Cutting Balloon Angioplasty Followed by Bare Metal Stent Implantation for Treating Ostial Left Anterior Descending Artery Lesions

Gao

Chen

Yang

et al. 2009

Clinical Cardiology

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Background: Drug-eluting stents (DES) are superior to bare metal stents (BMS) for treating ostial left anterior descending artery (LAD) lesions, but DES is not suitable for all patients in real life practice. Hypothesis: We hypothesize that cutting balloon angioplasty (CBA) followed by BMS (CBA + BMS) for treating ostial LAD lesions is an alternative strategy. Methods: In our study, 101 consecutive patients (51 with DES and 50 with CBA + BMS) with ostial LAD stenting were included for retrospective investigation between November 2003 and May 2005. The target vessel diameter was ≥ 3.0 mm. Results: We compared the DES group with the CBA + BMS group, the rates of restenosis (10.3% versus 17.9%, p = 0.386), target lesion revascularization (TLR) (5.88% versus 10%, p = 0.487) and major adverse cardiac events (MACE) (7.84% versus 12%, p = 0.525) were similar at 6-8 months angiographic follow-up, but there were higher bleeding events in the DES group (p = 0.033). During a 2-year clinical follow-up, no myocardial infarction occurred in the 2 groups, the rates of TLR (7.84% versus 10%, p = 0.741) and MACE (9.8% versus 12%, p = 0.723) were also similar. The MACE-free survival rate was 90.2% versus 88 % (p = 0.723). Conclusions:The CBA + BMS combination has a good long-term clinical effect in the treatment of ostial LAD lesions; it might be an alternative strategy for patients with contraindication for DES implantation, or patients who cannot endure long-term dual antiplatelet medication, or in elderly patients. IntroductionOstial lesions of the coronary artery are a challenge for interventional cardiologists. Conventional balloon angioplasty is ineffective in treating ostial lesions because of high rates of immediate recoil and long-term restenosis. The higher concentration of elastic and muscle fibers around the ostium is the reason for the recoil after balloon inflations. 1 The restenotic rate occurs in approximately 15%-45% of patients after implantation of bare metal stents (BMS) for treating ostial left anterior descending artery (LAD) lesions. 2,3 Randomized clinical trials have proved that the drug-eluting stent (DES) is superior to BMS in de novo lesions, 4,5 but cardiologists are not yet confident of the long-term safety of DES. 6,7 In addition, DES is not suitable for all patients, especially the elderly or patients with contraindication for DES implantation, or patients who cannot endure long-term dual antiplatelet medication. Cutting balloon angioplasty (CBA) followed by BMS (CBA + BMS) insertion in the treatment

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‘Optimal’ Directional Coronary Atherectomy

Abstract: Optimal DCA produced a low residual percent diameter stenosis and a lower restenosis rate than seen in previous trials without an increase in early or late major adverse events.

Cited by 125 publications

References 14 publications

Carvedilol for Prevention of Restenosis After Directional Coronary Atherectomy

Carvedilol for Prevention of Restenosis After Directional Coronary Atherectomy

Are Patients With Renal Failure Good Candidates for Percutaneous Coronary Revascularization in the New Device Era?

Long‐Term Clinical Efficacy of Cutting Balloon Angioplasty Followed by Bare Metal Stent Implantation for Treating Ostial Left Anterior Descending Artery Lesions

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