Pullback atherectomy for the treatment of intrastent restenosis

Chow, Wing‐Hing; Chan, T.F.

doi:10.1002/(sici)1097-0304(199705)41:1<94::aid-ccd21>3.0.co;2-p

Cited by 9 publications

(3 citation statements)

References 8 publications

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“…In patients at high risk for clinical recurrence treatment of ISR, removal of the hyperplastic tissue within the stent using extraction [18 -20], directional [11][12][13]32], pullback [33], and rotational [14 -17] atherectomy has been tried in an effort to expand the stent struts more effectively with balloon dilatation and reduce the matrix substrate for subsequent neointimal tissue growth. The most extensive clinical experience with these novel devices has been with the use of rotational atherectomy; several studies have reported high procedural success rates and infrequent complications following rotational atherectomy for ISR [14 -17].…”

Section: Other Revascularization Methods For Isrmentioning

confidence: 99%

Clinical and angiographic outcome in the laser angioplasty for restenotic stents (LARS) multicenter registry

Giri

Ito

Lansky

et al. 2001

Cathet. Cardiovasc. Intervent.

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In-stent restenosis (ISR), when treated with balloon angioplasty (PTCA) alone, has an angiographic recurrence rate of 30%-85%. Ablating the hypertrophic neointimal tissue prior to PTCA is an attractive alternative, yet the late outcomes of such treatment have not been fully determined. This multicenter case control study assessed the angiographic and clinical outcomes of 157 consecutive procedures in 146 patients with ISR at nine institutions treated with either PTCA alone (n = 64) or excimer laser assisted coronary angioplasty (ELCA, n = 93)) for ISR. Demographics were similar except more unstable angina at presentation in ELCA-treated patients (74.5% vs. 63.5%; P = 0.141). Lesions selected for ELCA were longer (16.8 +/- 11.2 mm vs. 11.2 +/- 8.6 mm; P < 0.001), more complex (ACC/AHA type C: 35.1% vs. 13.6%; P < 0.001), and with compromised antegrade flow (TIMI flow < 3: 18.9% vs. 4.5%; P = 0.008) compared to PTCA-treated patients. ELCA-treated patients had similar rate of procedural success [93 (98.9% vs. 62 (98.4%); P = 1.0] and major clinical complications [1 (1.1%) vs. 1 (1.6%); P = 1.0]. At 30 days, repeat target site coronary intervention was lower in ELCA-treated patients (1.1% vs. 6.4% in PTCA-treated patients; P = 0.158), but not significantly so. At 1 year, ELCA-treated patients had similar rate of major cardiac events (39.1% vs. 45.2%; P = 0.456) and target lesion revascularization (30.0% vs. 32.3%; P = 0.646). These data suggest that ELCA in patients with complex in-stent restenosis is as safe and effective as balloon angioplasty alone. Despite higher lesion complexity in ELCA-treated patients, no increase in event rates was observed. Future studies should evaluate the relative benefit of ELCA over PTCA alone for the prevention of symptom recurrence specifically in patients with complex in-stent restenosis.

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Section: Other Revascularization Methods For Isrmentioning

confidence: 99%

Clinical and angiographic outcome in the laser angioplasty for restenotic stents (LARS) multicenter registry

Giri

Ito

Lansky

et al. 2001

Cathet. Cardiovasc. Intervent.

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“…In a series of trials the final lumen was larger after directional atherectomy than after PTCA (2.7 ±0.4 mm versus 2.2 +0.5 mm, p<0.0005), and late events were less frequent after directional atherectomy than after PTCA (10.5% versus 39%, p = 0.03). 42 The main restrictions on the use of directional atherectomy are the necessity to use guiding catheters of a large diameter lOF (3.3 mm), a possibility of partial elimination of the stent, and complexity of working with lesions longer than 15 mm and also in vessels less than 3 mm. 20 ±396 pulses were delivered during 29 ±16 seconds.…”

Section: Treatment Of In-stent Restenosismentioning

confidence: 99%

Current Role of Laser Angioplasty of Restenotic Coronary Stents

Batyraliev¹,

Pershukov

Niyazova-Karben³

et al. 2006

Angiology

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Treatment of in-stent restenosis (ISR) with conventional percutaneous transluminal coronary angioplasty (PTCA) causes significant recurrent neointimal tissue growth in 30-85%. Therefore, laser ablation of intrastent neointimal hyperplasia before balloon dilation can be an attractive alternative. However, the long-term outcomes of such treatment have not been studied thoroughly enough. This prospective case-control study evaluated angiographic and clinical outcomes of PTCA alone and a combination of excimer laser coronary angioplasty (ELCA) and adjunct PTCA in 125 patients with ISR. ELCA was performed before balloon dilation in 67 patients, PTCA alone was performed in 58 patients. Basic demographic and clinical data were comparable in both groups. Lesions included in ELCA group were longer (17.1+/-9.9 vs 13.6+/-9.1 mm; p = 0.034), more complex (36.5% type C stenoses vs 14.3%; p = 0.006), and more frequently had reduced distal blood flow (TIMI <3: 18.9% vs 4.8%; p = 0.025) compared to lesions in the PTCA group. Immediate angiographic results of PTCA and ELCA + PTCA appeared to be comparable. PTCA alone was successful in 57 patients (98.3%), ELCA + PTCA, in 66 patients (98.5%). The rates of hospital complications were comparable (3.0% in ELCA group vs 8.6% in PTCA group). The 1-year follow-up showed that the rates of major adverse cardiac events (MACE) were comparable in the 2 groups (37.3% in ELCA group vs 46.6% in PTCA group). The rates of target vessel revascularization (TVR) within 1 year after the intervention were also similar in the 2 groups (32.8% vs 34.5%). The data mean that ELCA in patients with complex ISR is efficient and safe. Despite a higher complexity of lesions in the ELCA group, no increase in the rate of complications was registered.

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“…Bei der PullbackAtherektomie kommt ein Katheter zum Einsatz, der atheromatöse Plaques oder stenosierendes Gewebe zirkumferentiell schneiden und aufnehmen kann, um dann das Material anschließend mit dem Katheter aus dem Koronargefäß zu entfernen. Damit unterscheidet sich der Katheter deutlich von der direktionalen und auch von der Rotations-Atherektomie (13)(14)(15)(16)(17)(18).…”

Section: Pullback Atherectomy: An Alternative In the Treatment For Deunclassified

Pullback-Atherektomie: Ein alternatives Verfahren zur Behandlung von Koronarstenosen und in-Stent-Restenosen

Lins

El-Mokhtari

et al. 2002

Z Kardiol

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Optimized directional coronary atherectomy (DCA) has shown significantly superior acute and long-term results compared to conventional balloon angioplasty (BA). Nevertheless DCA has remained a niche application due to specific procedural aspects. The pullback atherectomy catheter (PAC), developed to retrieve atheromatous plaque material, is an alternative debulking device. We report on clinical and angiographic experience in 55 consecutive patients, in whom de novo lesions (35 pts) as well as instent restenoses (17 pts) were treated. The minimal luminal diameter (MLD, mm) rose after PAC and additional BA from 1.06 +/- 0.53 to 2.68 +/- 0.48 and from 1.10 +/- 0.48 to 2.55 +/- 0.49 mm, respectively. A stenosis reduction from 69 +/- 13 to 19 +/- 16 and from 64 +/- 15 to 16 +/- 10%, resp., could be documented. After 3-6 months a complete angiographic follow-up showed MLD values of 2.01 +/- 0.69 and 1.88 +/- 0.61 mm. Nine of 35 (26%) vs. 5 of 17 (29%) pts developed significant restenosis at the treated site (diameter stenoses > 50%). Stent implantation was necessary to achieve an optimal acute angiographic result or due to dissection in 17 vs. 5 pts. Major cardiac events did not occur; however, two restenosed coilstents were removed by PAC. With the pullback atherectomy catheter, a safe and effective alternative device is available for the treatment of coronary lesions and also of in-stent restenosis. Promising short and acceptable long-term results are comparable to those of other debulking procedures.

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Pullback atherectomy for the treatment of intrastent restenosis

Cited by 9 publications

References 8 publications

Clinical and angiographic outcome in the laser angioplasty for restenotic stents (LARS) multicenter registry

Clinical and angiographic outcome in the laser angioplasty for restenotic stents (LARS) multicenter registry

Current Role of Laser Angioplasty of Restenotic Coronary Stents

Pullback-Atherektomie: Ein alternatives Verfahren zur Behandlung von Koronarstenosen und in-Stent-Restenosen

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