Acute directional coronary atherectomy prior to stenting in complex coronary lesions: ADAPTS study

R. Stefan Kiesz, M. Marius Rozek, David M. Mego, Vipool Patel, Douglas G. Ebersole, Robert J. Chilton

Research output: Contribution to journalArticlepeer-review

17 Scopus citations


The purpose of this study was to determine the results of directional coronary atherectomy (DCA) combined with stenting in a high-risk patient population. The use of stenting or DCA alone for aorto-ostial lesions, total chronic occlusions, long lesions, and lesions containing thrombus is associated with lowered success and a relatively high restenosis rate. Between July 1993 and October 1996, we treated 89 lesions with the combined approach of DCA and stenting in 60 consecutive patients. Thirty-one (51.7%) patients were treated because of unstable angina, 11 (18.3%) for post- myocardial infarction (MI) angina, 3 (5.0%) for acute MI, and 15 (25.0%) patients for stable angina. A total of 43 (71.7%) patients had multivessel disease, 19 (31.7%) had undergone previous coronary artery bypass graft (CABG), and 17 (28.3%) patients had undergone multivessel revascularization. The procedure was successful in all patients; and no postprocedural deaths or emergent CABG occurred. Two patients (3.3%) had non-Q-wave MI after the procedure and I patient (1.7%) experienced Q-wave MI due to subacute stent closure 7 days after the procedure. During follow-up ranging from 6 months to 3 years, 2 (3.3%) patients died, 2 (3.3%) required CABG surgery, 1 (1.7%) patient had an MI, and 6 patients (10.0%) required target vessel revascularization. By the quantitative coronary angiography, the initial minimal luminal diameter (MLD) averaged 0.91 ± 0.45 mm (74.7 ± 11.8% stenosis) increasing to 3.80 ± 0.44 mm (-6.7 ± 12.1%) after the combined approach procedure. Thirty patients (50.0%) met criteria for late (≤6 months) angiographic follow-up. Late MLD loss averaged 1.13 ± 1.07 mm, for a mean net gain of 1.61 ± 1.23 mm. Available angiographic follow-up evaluation showed a restenosis rate of 13.3%. A combined approach, defined as the use of both DCA and stenting, is safe and yields a low restenosis rate in high-risk patients who have lesions known to respond less favorably to stenting or DCA alone.

Original languageEnglish (US)
Pages (from-to)105-112
Number of pages8
JournalCatheterization and Cardiovascular Diagnosis
Issue number2
StatePublished - Oct 1998


  • Atherectomy
  • Complex lesions
  • Restenosis
  • Stents

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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