Directional Coronary Atherectomy: Primary Success and Early Outcome

In this study, we examined 47 patients wo had undergone directional coronary atherectomy (DCA), in order to evaluate the early outcome. The procedure was performed to 47 lesions of 44 male and 3 female patients (mean age 53±8). The lesion sites were left anterior descending in 39, right coronary in 7 patients and circumflex artery in 1 patient (44 non-ostial eccentric lesions, 2 ostial lesions, and 1 post-PTCA short dissection). 38 of them were "de novo" lesions and 9 restenosis. The procedural success was 93.6% and the clinical success 89.4%. The mean diameter stenosis decreased from 82.8±10.5% to 12.8±11.8% (p<(10)-6). On average 5.8 specimens (3-5) per patient were removed. In 17 lesions (41.3%) adjunctive balloon angioplasty were performed. Two patients were referred for emergency coronary by-pass surgery (because of abrupt closure in one and perforation in the other patient). Q wave myocardial infarction (MI) occured in one patient (2.1%), non-Q MI in one patient (2.1%), subacute occlusion successfully treated by thorombolysis and PTCA in one patient (2.1%), side branch loss in one patient (2.1%) and non-occlusive dissection in two patients (4.2%). Major complication rate was 6.3% and minor 10.5%. We concluded that DCA can be performed effectively in non-angulated, non-tortuous and non-calcific proximal lesions shorter than 20 mm, and is a method that increase the operator's perfomance in complex lesions.