Combined percutaneous coronary atherectomy and coronary angioplasty: Experience in 19 consecutive patients

• Published in: Journal of the American College of Cardiology Vol. 15; no. 5; pp. 1146 - 1150
• Main Authors: Bell, Malcolm R., Kaufmann, Urs P., Vlietstra, Ronald E., Holmes, David R.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.04.1990; Elsevier Science
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; Cardiac Catheterization - adverse effects; Cardiac Catheterization - methods; Cardiology. Vascular system; Coronary Artery Disease - surgery; Coronary heart disease; Female; Heart; Humans; Male; Medical sciences; Middle Aged; Prospective Studies; Human; Associated technique; Coronary artery; Cuffed tube; Instrumentation therapy; Cardiovascular disease; Instrumental dilatation; Technique; Coronary heart disease
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/0735-1097(90)90256-O

Among 82 patients undergoing coronary atherectomy, 19 (23%) underwent this procedure in combination with coronary angioplasty. The most frequently involved vessel was the left anterior descending coronary artery. In 11 patients (58%), attempted atherectomy preceded coronary angioplasty. In 6 of the 11, angioplasty was used after the atherectomy catheter could not be positioned across the lesion; 4 patients underwent “rescue” angioplasty after developing vessel occlusion related to atherectomy and 1 patient had an unsatisfactory result of atherectomy. The success rate of the combined intervention was 82% for these 11 patients. In eight patients (42%), atherectomy was performed after initial angioplasty. In four of the eight, atherectomy was a rescue procedure to manage vessel occlusion by thrombus or intimal dissection and was successful in three. In the other four, angioplasty was performed to establish an easier passage for the atherectomy catheter and was successful in three. Thus, the success rate of the combined intervention was 75% for these eight patients. The overall success rate for all 19 patients was 79%; there was one in-hospital death and one non-Q wave infarction, and one patient required immediate coronary artery surgery. Two other patients underwent coronary artery surgery before hospital discharge. Combined intervention with coronary angioplasty and atherectomy seems to be a relatively safe and effective approach in selected patients when either of these procedures alone is unsuccessful or is accompanied by acute coronary complications.