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Does Adjuvant Stenting After Coronary Rotablation Affect Restenosis Rate !. Layth A. Mimish, M. Bakhshi, J. Buraiki, A. Patel, K. Niazi, M. E. Fawzy, B. Dajani, B. Dunn K.F.S.H. & R.C. Riyadh, Saudi Arabia. The Goal of The Study.
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Does Adjuvant Stenting After Coronary Rotablation Affect Restenosis Rate ! Layth A. Mimish, M. Bakhshi, J. Buraiki, A. Patel, K. Niazi, M. E. Fawzy, B. Dajani, B. Dunn K.F.S.H. & R.C. Riyadh, Saudi Arabia
The Goal of The Study • Retrospective analysis of all cases who underwent conary revascularization with high speed rotational atherectomy from October 1993 - October 1997 • Comparison of angiographic restenosis rates between patients who had HSRA +ballooning, and those who had additional stenting at the end of the procedure
Indications of Rotablation • Calcification in the coronary lesion on floroscopy • Inability to dilate with high atmospheric pressures • Inability to cross the lesion with 1.5 mm balloon • Participation in the Effect of Debulking on Restenoses Study (EDRESS)
Indications of Stenting • Coronary dissection unresolved by prolonged balloon inflaton • Residual stenosis more than 40% • Part of the EDRESS protocol
Rotablation • 10,000 U IV Heparin before procedure • Small Burr Size with larger Burrs if needed • Multiple short passes • No significant drop in RPM • Multiple doses of I.C. NTG and Verapamil • Ballooning in all cases
Stenting • Ticlopidine 250 mg • ACT 250-300 • 14-16 Atmospheres deployment pressure • Multiple post deployment angiographic views • Sheath removal within 3 hrs. • Ticlopidine BID, ASA for 1 month
Demographic Data • October 1993-1997, 183 cases • 147 males and 36 females • Mean age 57+-11 years • LAD 102, Diagonal 2, Intermediate 2, Circumflex/OM 27, RCA 50 cases • Lesion type B-C 84% • Stenting in 72 cases
Rotablation • Mean Burr Size 1.9 +- 0.3 mm • Mean number of passes 4+-2 • Ablation time 99+-59 sec • All lesion were dilated with a balloon post HSRA • Success rate 95%
No. 109 Age 58.5+-10 M/F 82/27 Hx MI 55/109 QMI 40/55 Hx PTCA 40/109 73 55.3+-11 63/10 48/73 43/48 11/73 Demographic &clinical dataRotablation Rota+Stenting
LAD 64/109 36/73 Cx/OM 16/109 8/73 RCA 24/109 27/73 Total Occlusion 22/109 9/73 Size 2.9+-0.5 3.2+-0.3 Type A 24 29 Type B 76 24 Type C 9 20 Demographic &clinical dataRotablation Rota+Stenting
Burr size 1.8+-0.3 No. Burrs 1.2+-0.5 No. Passes 3.5+-1.7 Ablation 84+-46 Ca ++ 69 Failed Balloon 9 2.1+-0.3 1.2+-0.5 3.5+-1.7 126+-63 26 3 Demographic &clinical dataRotablation Rota+Stenting
Success 101(93%) Failure 8 Death 2 (1.8%) Acute MI 2 CABG 4 Dissection 17 Non QMI 3 72(98.6%) 3 0 0 1 6 0 Demographic &clinical dataRotablation Rota+Stenting
6 Months Angiographic follow up • Available on 90% of patients who completed 6 months after the procedure • Restenoses in the total group was 38.7% • Restenoses in the stented group was 34.3% • Restenoses in the non-stented group was 42.5%
Conclusion • There was 12.9% reduction in restenoses in stented group • Total numbers were small • Mean vessel size was larger than average • Restenoses remains high even with stenting