Side-branch occlusion with directional coronar atherectomy: Incidence and risk factors

• Published in: The American heart journal Vol. 128; no. 4; pp. 686 - 690
• Main Authors: Campos-Esteve, Miguel A., Laird, John R., Kufs, William M., Wortham, Dale C.
• Format: Journal Article
• Language: English
• Published: Mosby, Inc 1994
• ISSN: 0002-8703; 1097-6744
• DOI: 10.1016/0002-8703(94)90265-8

Side-branch occlusion is a recognized complication of directional coronary atherectomy (DCA). To evaluate the incidence, risk factors, and clinical outcome of side-branch compromise, we analyzed our first 100 consecutive atherectomies of native coronary arteries. Seventy-eight patients had 122 side branches at risk, 21 (17%) of which demonstrated compromised flow after DCA. Origin of the side branch from the culprit atheroma and preexisting side-branch ostial stenosis were highly predictive of this complication in 20 of 55 ( p < 0.05) and 14 of 31 ( p < 0.05) lesions, respectively. There was one non-Q-wave myocardial infarction, no emergency surgeries, and no deaths. In conclusion, side-branch loss after DCA occurs with a frequency similar to balloon angioplasty and was well tolerated in our patient population. Side branches that originate directly from culprit lesions or that have significant ostial narrowing have a higher incidence of this complication.