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Directional Coronary Atherectomy KFSH & RC Experience

Directional Coronary Atherectomy KFSH & RC Experience. Layth A. Mimish, J. Buraiki, M. E. Fawzy, B. Dunn, M. Bakhshi, B. Dajani. DCA. 1st case performed in KFSH in December 1991. Total 149 cases 1992 21 cases 1993 35 cases 1994 38 cases

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Directional Coronary Atherectomy KFSH & RC Experience

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  1. Directional Coronary AtherectomyKFSH & RC Experience Layth A. Mimish, J. Buraiki, M. E. Fawzy, B. Dunn, M. Bakhshi, B. Dajani

  2. DCA • 1st case performed in KFSH in December 1991. Total 149 cases • 1992 21 cases • 1993 35 cases • 1994 38 cases • 1995 52 cases • 1996/97 3 cases

  3. Demographic & Clinical Data • Mean Age 52.4+-9 years • Males/Females 136/13 • CCS class II-IV 140/149 • History of MI 83(67 QMI) • Restenotic lesions 36

  4. DCA • LAD 121 • Circumflex 9 • Intermediate 1 • RCA 18 • 33 procedures were done to shave dissection flaps ( 24 are salvage procedures)

  5. DCA • Mean artery size 3+-0.5mm • Atherocath sizes 5 F 19 6F 75 7F 55

  6. Additional procedures • PTCA 92 • Thrombolysis 4 • Stenting 2 • PCPBS 3

  7. Success & Major Comlications • Successful in 142/149 cases (95.3%) • In 2 patients Atherocath could not be advanced despite predilatation • In 5 patients emergency CABG had to be done, with one mortality post CABG • No QMI

  8. Minor Complications • Acute occlusion 4 • Ventricular Fibrillation 1 • Transient Arrhythmias 2 • Long dissection 2 • Haematoma 2 • Non QMI 13 • Coronary Embolus 5

  9. 6 Months angiographic follow up • Cathetarization performed on 139 of the 142 patients who had successful atherectomy. • Restenoses in 46/139 patients (33%)

  10. Conclusion • DCA is an effective tool for coronary revascularization which carries a high success rate and in large vessels an acceptable restenosis rate • Technically it is more demanding than simple GOBA

  11. Debulking Revisited Layth A. Mimish Consultant Cardiologist The Cardiovascular Consultant Group Jeddah, Saudi Arabia

  12. Percutaneous Revascularization • Initial gain with device • Mechanism of initial gain • Lesion specific device • IVUS • Initial loss (recoil) • Injury and cellular proliferation

  13. Percutaneous Revascularization • Initial gain with device • Mechanism of initial gain • Lesion specific device • IVUS • Initial loss (recoil) • Injury and cellular proliferation

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