Preliminary experience at a Canadian centre with directional coronary atherectomy for complex lesions.
OBJECTIVE
To evaluate preliminary experience of directional coronary atherectomy for complex coronary artery lesions.


DESIGN
Nonrandomized, sequential patients with coronary arterial lesions that were ostial, eccentric, bulky, recurrent or membranous.


SETTING
Cardiac catheterization laboratory of a tertiary referral general hospital.


PATIENTS
Twenty-three patients with angina pectoris refractory to medical therapy who were suitable candidates for coronary bypass surgery.


INTERVENTIONS
Directional coronary atherectomy with associated balloon angioplasty, if required, to reduce lesion stenosis to less than 25%.


MAIN RESULTS
Primary success was achieved in 29 of 33 lesions (88%) by atherectomy alone and in 31 of 33 lesions (94%) by additional use of balloon angioplasty. Atherectomy retrieved tissue in 30 of 33 attempts (91%). One patient suffered Q wave myocardial infarction; one had acute occlusion after atherectomy requiring emergency balloon angioplasty; and one required repair of a false aneurysm of the femoral artery.


CONCLUSIONS
Directional coronary atherectomy is safe and efficacious for ostial, bulky and eccentric lesions not optimally suited to balloon angioplasty. Lesions which have tortuous segments immediately beyond, restricting movement of the stiff nose-cone, and which are membranous or bandlike, may not be indicated for directional coronary atherectomy.