Randomized Comparison of Angioplasty of Complex Coronary Lesions at a Single Center

Reifart, Nicolaus; Vandormael, Michel; Krajcar, Mladen; Göhring, Stefan; Preusler, W; Schwarz, Franz; Störger, Hans; Hofmann, Manfred; Klöpper, Johann W.; Müller, Stefan; Haase, Jürgen

doi:10.1161/01.cir.96.1.91

Cited by 285 publications

(41 citation statements)

References 16 publications

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“…The clinical efficacy of two ablative devices, excimer laser coronary angioplasty and rotational atherectomy, was examined relative to that of balloon angioplasty in the randomized ERBAC study of 620 patients with high-risk (American College of Cardiology/American Heart Association type B or C) angiographic lesion morphology. 2 Despite significantly improved procedural success in patients randomized to rotational atherectomy relative to the other treatment strategies, neither of the new devices resulted in a reduction in the 6-month angiographic restenosis rate. Repeat target lesion revascularization actually was more frequent in patients who underwent laser angioplasty and rotational atherectomy than in those treated with balloon angioplasty (46% versus 46% versus 35%; respectively; Pϭ.04).…”

Section: Debulking and Ablative Techniquesmentioning

confidence: 99%

A Call for Provisional Stenting

1998

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During the past 20 years, the equipment used to perform percutaneous coronary revascularization has undergone a dramatic transformation from simple balloon dilatation catheters to sophisticated mechanical devices and endoprostheses. The impetus for this evolution in technology was initially a byproduct of suboptimal immediate and long-term results obtained with standard balloon angioplasty. New techniques, including directional and rotational atherectomy, have resulted in improved procedural success rates, especially for more complex lesion subtypes, although their ability to curtail restenosis remains controversial.1,2 Intracoronary stents have had a dramatic impact on reduction of the incidence of acute complications after failed balloon angioplasty and represent the only currently available strategy shown to limit both clinical and angiographic restenosis. 3-12Based on these advantages, stent implantation is used in approximately half of all percutaneous interventions in the United States. However, despite their proven benefits, coronary stents continue to be accompanied by several theoretical and practical limitations: they are costly, typically associated with a more marked degree of neointimal formation than balloon angioplasty, and difficult to use with some lesion subsets such as bifurcation stenoses, and they have engendered the new and difficult-to-treat entity of in-stent restenosis.Although the major focus in the field of interventional cardiology over the past decade has been on the development of new devices and adjunctive pharmacological therapies, the short-and long-term success rates after standard balloon angioplasty have improved significantly. Part of the improvement is likely a manifestation of enhanced operator experience and better equipment, but the results of balloon angioplasty have also benefited greatly from the availability of coronary stents for both "bailout" (for actual or threatened abrupt closure) or "backup" (for suboptimal balloon results) indications, potentially allowing a strategy of more aggressive balloon dilatation than could be safely performed in the pre-stent era. This report details the forces that resulted in the shift from reliance on balloon angioplasty as the primary mode of therapy for the majority of percutaneous interventions and, with the use of data from several recent clinical trials, will provide the rationale for a potential return to the use of balloon angioplasty (with provisional stent placement) as the predominant means of coronary revascularization.

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Section: Debulking and Ablative Techniquesmentioning

confidence: 99%

A Call for Provisional Stenting

1998

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“…Therefore, RA has been used in these lesion subsets in nonrandomized and randomized studies (Table II) with high procedural success rates (80 -98%) [17,[22][23][24][25]. Despite comparable or even better procedural success with the use of RA in this setting, the randomized Excimer Laser, Rotational Atherectomy, and Balloon Angioplasty Comparison (ERBAC) [25] …”

Section: Complex Lesionsmentioning

confidence: 99%

Current status of rotational atherectomy

Çavuşoğlu¹,

Kini²,

Marmur³

et al. 2004

Cathet Cardio Intervent

114

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Despite the increasing use of percutaneous transluminal coronary angioplasty and intracoronary stent placement for the treatment of obstructive coronary artery disease, a large subset of coronary lesions cannot be adequately treated with balloon angioplasty and/or intracoronary stenting alone. Such lesions are often heavily calcified or fibrotic and undilatable with the present balloon technology and attempts to treat them with balloon angioplasty or intracoronary stent placement often lead to vessel dissection or incomplete stent deployment with resultant adverse outcomes. Rotational atherectomy remains a useful niche device for the percutaneous treatment of such complex lesions, usually as an adjunct to subsequent balloon angioplasty and/or intracoronary stent placement. In contrast to balloon angioplasty or stent placement that widen the coronary lumen by displacing atherosclerotic plaque, rotational atherectomy removes plaque by ablating the atherosclerotic material, which is dispersed into the distal coronary circulation. Other lesion subtypes amenable to treatment with this modality include ostial and branch-ostial lesions, chronic total occlusions, and in-stent restenosis. This review discusses the technique and principles of rotational atherectomy, the various treatment strategies for its use (including adjunctive pharmacotherapy), the lesion-specific applications for this device, and the complications unique to this modality. Recommendations are also made for its use in the current interventional era.

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“…In contrast, other new devices including the rotablator, directional coronary atherectomy and laser angioplasty accounted for only 3·5% of all coronary interventions during 1995 and have not expanded during the past 4 years. The technical complexity, cost issues, and the potential for increased morbidity without translating into a clear-cut clinical benefit explain the reservation of these devices for niche applications [34][35][36] . Data on catheterization facilities and operators were provided by 17 countries representing a population of 240 million people.…”

Section: Working Group Report 491mentioning

confidence: 99%

Interventional cardiology in Europe 1995

Windecker¹

1999

European Heart Journal

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on behalf of the working group Coronary Circulation of the European Society of CardiologyThe working group Coronary Circulation of the European Society of Cardiology conducts, with the support of the national societies of cardiology, an annual survey on cardiac interventions in Europe. This report is the fourth consecutive summary on cardiac interventions in Europe and gives an overview of interventional cardiology activities during 1995 in 30 member countries of the European Society of Cardiology, representing a population of 550 million people.Coronary angiography A total of 1 065 485 diagnostic coronary angiograms were reported, a 15% increase compared with 1994. The mean incidence of coronary angiograms increased to 1937 per 10 6 inhabitants, ranging from 4667 per 10 6 inhabitants in Germany to 67 per 10 6 inhabitants in Romania.Coronary angioplasty A total of 278 982 coronary angioplasty (PTCA) procedures were reported, an increase of 24% compared with 1994. The mean incidence of coronary angioplasty per capita was 507 per 10 6 inhabitants, ranging from 1358 per 10 6 inhabitants in Germany to 12 per 10 6 inhabitants in Romania. The ratio of PTCAs per coronary angiogram was 0·26, ranging from 0·40 in the Netherlands to 0·08 in Cyprus. Ad hoc PTCA (combined diagnostic angiography and PTCA) accounted for 24% of all PTCA cases. The majority (85%) of PTCA procedures were restricted to a single vessel.Coronary stenting Coronary stents were used in 80 383 coronary interventions, an increase of 272% compared with 1994, representing the fastest growth. The European mean ratio of coronary stenting per PTCA procedure was 0·29.Other new devices Other new interventional therapeutic devices were employed in 9798 cases, accounting for 3·5% of all coronary interventions. Coronary ultrasound was used in 4787 (1·7%) and coronary angioscopy in 543 interventions (0·2%). Non-coronary interventionsBalloon valvuloplasty remained the most frequent non-coronary intervention during 1995 with a total of 2715 mitral, 615 pulmonary, and 719 aortic valvuloplasties.Catheterization facilities There were a mean of 2·5 diagnostic cardiac catheterization institutions with a mean of 3·4 diagnostic laboratories per 10 6 inhabitants in Europe. The number of PTCA institutions and laboratories were a mean of 0·7 and 0·9 per 10 6 inhabitants, respectively. The mean numbers of trained operators were 11 for diagnostic cardiac catheterization and eight for PTCA per 10 6 inhabitants. On average, 704 yearly coronary angiograms per diagnostic catheterization laboratory and 203 yearly PTCAs per PTCA laboratory were reported in Europe. The average operator performed 210 coronary angiograms and 78 PTCAs per year.Conclusions During 1995, coronary angiography increased at a mean annual rate of 10% and coronary angioplasty at a mean annual rate of nearly 20% in Europe. Coronary angioplasty was employed on a single vessel per procedure in the majority of cases. Coronary stenting remained the fastest growing procedure in interventional cardiology and the Europe...

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Randomized Comparison of Angioplasty of Complex Coronary Lesions at a Single Center

Abstract: Procedural success of rotational atherectomy is superior to laser angioplasty and balloon angioplasty; however, it does not result in better late outcomes. The role of plaque debulking before balloon dilatation in percutaneous coronary revascularization remains to be fully defined.

Cited by 285 publications

References 16 publications

A Call for Provisional Stenting

A Call for Provisional Stenting

Current status of rotational atherectomy

Interventional cardiology in Europe 1995

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