Outcome after
intracoronary Pullback Atherectomy: Quantitative Angiographic results from a
Multicenter Registry R Prpic*,
J J Popma, S Kinlay, M Adams, O-H Kwok, Brigham and
Women's Hospital, Boston, MA, USA Objectives: To evaluate the angiographic outcome of patients undergoing
intracoronary pullback atherectomy with adjunctive balloon angioplasty
in an international multicenter registry. Background: Contemporary
aggressive `optimal' directional coronary atherectomy has been shown to provide
significantly higher short-term success and lower angiographic restenosis than
conventional balloon angioplasty, without an increase in major adverse events.
The Arrow-FischellTM pullback
atherectomy catheter (PAC) is a retrograde cutting device that is designed to
debulk and retrieve atheromatous plaque circumferentially. Methods
and Results: A retrospective analysis of patients undergoing pullback atherectomy
using the prototype PAC device was performed. Complete quantitative coronary
angiography data was obtained before and after intervention. A total of 165
patients were enrolled in 6 centers. Immediate angiographic success was
achieved in 95.8% of cases. Mean reference vessel diameter was 3.14+/-0.48mm.
Minimal luminal diameter was increased from 0.99+/-0.37mm to 2.58+/-0.66mm. The
acute gain after PAC was 0.75+/-0.67mm. Mean diameter stenosis was reduced from
67.9% at baseline to a final residual stenosis of 20.1%. Angiographic complications after atherectomy
included major dissection in 2.6%, vessel perforation in 2.6% and abrupt
closure in 3.9%. Significant distal coronary spasm was identified in 19.5% of
cases after atherectomy. The major predictor of complications was non-ostial
lesion location. Conclusions: Pullback atherectomy is an effective method of plaque removal
for coronary artery disease. Modification of the prototype design may be
indicated to reduce the incidence of distal coronary spasm.
