Mechanical debulking versus balloon angioplasty for the treatment of true bifurcation lesions
Objectives. The purpose of this study was to compare the immediate angiographic and long-term results of debulking versus balloon angioplasty for treatment of true bifurcation lesions. Background. Previous studies have shown true bifurcation lesions to be a high risk morphological subset for percuta...
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| Veröffentlicht in: | Journal of the American College of Cardiology 1998-12, Vol.32 (7), p.1845-1852 |
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| creator | Dauerman, Harold L. Higgins, Peter J. Sparano, Anthony M. Gibson, C.Michael Garber, Gary R. Carrozza, Joseph P. Kuntz, Richard E. Laham, Roger J. Shubrooks, Samuel J. Baim, Donald S. Cohen, David J. |
| description | Objectives. The purpose of this study was to compare the immediate angiographic and long-term results of debulking versus balloon angioplasty for treatment of true bifurcation lesions.
Background. Previous studies have shown true bifurcation lesions to be a high risk morphological subset for percutaneous transluminal coronary angioplasty (PTCA). Although atherectomy devices have been used to treat bifurcation lesions, no studies have compared the outcomes of these alternative treatment modalities.
Methods. Between January 1992 and May 1997, we treated 70 consecutive patients with true bifurcationlesions (defined as a greater than 50% stenosis in both the parent vessel and contiguous side branch) with conventional PTCA (n = 30) or debulking (with rotational or directional atherectomy) plus adjunctive PTCA (n = 40). Paired angiograms were analyzed by quantitative angiography, and clinical follow-up was obtained in all patients.
Results. Acute procedural success was 73% in the PTCA group and 97% in the debulking group (p = 0.01). Major in-hospital complications occurred in two patients in the PTCA group and one in the debulking group. Treatment with atherectomy plus PTCA resulted in lower postprocedure residual stenoses than PTCA alone (16 ± 15% vs. 33 ± 17% in the parent vessel, and 6 ± 15% vs. 39 ± 22% in the side branch; p < 0.001 for both comparisons). At 1 year follow-up, the incidence of target vessel revascularization (TVR) was 53% in the PTCA group as compared with 28% in the debulking group (p = 0.05). Independent predictors of the need for repeat TVR were side branch diameter >2.3 mm, longer lesion lengths, and treatment with PTCA alone.
Conclusions. For the treatment of true bifurcation lesions, atherectomy with adjunctive PTCA is safe, improves acute angiographic results, and decreases target vessel revascularization compared to PTCA alone. The benefits of debulking for bifurcation lesions were especially seen in lesions involving large side branches. |
| doi_str_mv | 10.1016/S0735-1097(98)00488-4 |
| format | Article |
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Background. Previous studies have shown true bifurcation lesions to be a high risk morphological subset for percutaneous transluminal coronary angioplasty (PTCA). Although atherectomy devices have been used to treat bifurcation lesions, no studies have compared the outcomes of these alternative treatment modalities.
Methods. Between January 1992 and May 1997, we treated 70 consecutive patients with true bifurcationlesions (defined as a greater than 50% stenosis in both the parent vessel and contiguous side branch) with conventional PTCA (n = 30) or debulking (with rotational or directional atherectomy) plus adjunctive PTCA (n = 40). Paired angiograms were analyzed by quantitative angiography, and clinical follow-up was obtained in all patients.
Results. Acute procedural success was 73% in the PTCA group and 97% in the debulking group (p = 0.01). Major in-hospital complications occurred in two patients in the PTCA group and one in the debulking group. Treatment with atherectomy plus PTCA resulted in lower postprocedure residual stenoses than PTCA alone (16 ± 15% vs. 33 ± 17% in the parent vessel, and 6 ± 15% vs. 39 ± 22% in the side branch; p < 0.001 for both comparisons). At 1 year follow-up, the incidence of target vessel revascularization (TVR) was 53% in the PTCA group as compared with 28% in the debulking group (p = 0.05). Independent predictors of the need for repeat TVR were side branch diameter >2.3 mm, longer lesion lengths, and treatment with PTCA alone.
Conclusions. For the treatment of true bifurcation lesions, atherectomy with adjunctive PTCA is safe, improves acute angiographic results, and decreases target vessel revascularization compared to PTCA alone. The benefits of debulking for bifurcation lesions were especially seen in lesions involving large side branches.</description><identifier>ISSN: 0735-1097</identifier><identifier>EISSN: 1558-3597</identifier><identifier>DOI: 10.1016/S0735-1097(98)00488-4</identifier><identifier>PMID: 9857861</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Aged ; Angioplasty, Balloon, Coronary ; Atherectomy, Coronary ; Coronary Angiography ; Coronary Disease - therapy ; Female ; Humans ; Male ; Middle Aged ; Regression Analysis ; Treatment Outcome</subject><ispartof>Journal of the American College of Cardiology, 1998-12, Vol.32 (7), p.1845-1852</ispartof><rights>1998 American College of Cardiology</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c508t-fae29b364e7b5362af7bca25c11e7f8ed6040a3155590b315366d9e147019ad3</citedby><cites>FETCH-LOGICAL-c508t-fae29b364e7b5362af7bca25c11e7f8ed6040a3155590b315366d9e147019ad3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/S0735-1097(98)00488-4$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/9857861$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Dauerman, Harold L.</creatorcontrib><creatorcontrib>Higgins, Peter J.</creatorcontrib><creatorcontrib>Sparano, Anthony M.</creatorcontrib><creatorcontrib>Gibson, C.Michael</creatorcontrib><creatorcontrib>Garber, Gary R.</creatorcontrib><creatorcontrib>Carrozza, Joseph P.</creatorcontrib><creatorcontrib>Kuntz, Richard E.</creatorcontrib><creatorcontrib>Laham, Roger J.</creatorcontrib><creatorcontrib>Shubrooks, Samuel J.</creatorcontrib><creatorcontrib>Baim, Donald S.</creatorcontrib><creatorcontrib>Cohen, David J.</creatorcontrib><title>Mechanical debulking versus balloon angioplasty for the treatment of true bifurcation lesions</title><title>Journal of the American College of Cardiology</title><addtitle>J Am Coll Cardiol</addtitle><description>Objectives. The purpose of this study was to compare the immediate angiographic and long-term results of debulking versus balloon angioplasty for treatment of true bifurcation lesions.
Background. Previous studies have shown true bifurcation lesions to be a high risk morphological subset for percutaneous transluminal coronary angioplasty (PTCA). Although atherectomy devices have been used to treat bifurcation lesions, no studies have compared the outcomes of these alternative treatment modalities.
Methods. Between January 1992 and May 1997, we treated 70 consecutive patients with true bifurcationlesions (defined as a greater than 50% stenosis in both the parent vessel and contiguous side branch) with conventional PTCA (n = 30) or debulking (with rotational or directional atherectomy) plus adjunctive PTCA (n = 40). Paired angiograms were analyzed by quantitative angiography, and clinical follow-up was obtained in all patients.
Results. Acute procedural success was 73% in the PTCA group and 97% in the debulking group (p = 0.01). Major in-hospital complications occurred in two patients in the PTCA group and one in the debulking group. Treatment with atherectomy plus PTCA resulted in lower postprocedure residual stenoses than PTCA alone (16 ± 15% vs. 33 ± 17% in the parent vessel, and 6 ± 15% vs. 39 ± 22% in the side branch; p < 0.001 for both comparisons). At 1 year follow-up, the incidence of target vessel revascularization (TVR) was 53% in the PTCA group as compared with 28% in the debulking group (p = 0.05). Independent predictors of the need for repeat TVR were side branch diameter >2.3 mm, longer lesion lengths, and treatment with PTCA alone.
Conclusions. For the treatment of true bifurcation lesions, atherectomy with adjunctive PTCA is safe, improves acute angiographic results, and decreases target vessel revascularization compared to PTCA alone. The benefits of debulking for bifurcation lesions were especially seen in lesions involving large side branches.</description><subject>Aged</subject><subject>Angioplasty, Balloon, Coronary</subject><subject>Atherectomy, Coronary</subject><subject>Coronary Angiography</subject><subject>Coronary Disease - therapy</subject><subject>Female</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Regression Analysis</subject><subject>Treatment Outcome</subject><issn>0735-1097</issn><issn>1558-3597</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1998</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkEtLAzEUhYMoWh8_oZCV6GI06UwyyUqk-IKKC91KyGTu1Gg6qUmm0H9vbItbV4fLPedezofQmJIrSii_fiV1yQpKZH0hxSUhlRBFtYdGlDFRlEzW-2j0ZzlCxzF-EkK4oPIQHUrBasHpCL0_g_nQvTXa4RaawX3Zfo5XEOIQcaOd877Hup9bv3Q6pjXufMDpA3AKoNMC-oR9l4cBcGO7IRidbE44iFniKTrotItwttMT9HZ_9zZ9LGYvD0_T21lhGBGp6DRMZFPyCuqGlXyiu7oxesIMpVB3AlpOKqLL3IxJ0mQtOW8l0KomVOq2PEHn27PL4L8HiEktbDTgnO7BD1FxScSEUpqNbGs0wccYoFPLYBc6rBUl6peq2lBVv8iUFGpDVVU5N949GJoFtH-pHca8v9nuIZdcWQgqGgu9gdYGMEm13v7z4QeXM4h1</recordid><startdate>199812</startdate><enddate>199812</enddate><creator>Dauerman, Harold L.</creator><creator>Higgins, Peter J.</creator><creator>Sparano, Anthony M.</creator><creator>Gibson, C.Michael</creator><creator>Garber, Gary R.</creator><creator>Carrozza, Joseph P.</creator><creator>Kuntz, Richard E.</creator><creator>Laham, Roger J.</creator><creator>Shubrooks, Samuel J.</creator><creator>Baim, Donald S.</creator><creator>Cohen, David J.</creator><general>Elsevier Inc</general><scope>6I.</scope><scope>AAFTH</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>199812</creationdate><title>Mechanical debulking versus balloon angioplasty for the treatment of true bifurcation lesions</title><author>Dauerman, Harold L. ; Higgins, Peter J. ; Sparano, Anthony M. ; Gibson, C.Michael ; Garber, Gary R. ; Carrozza, Joseph P. ; Kuntz, Richard E. ; Laham, Roger J. ; Shubrooks, Samuel J. ; Baim, Donald S. ; Cohen, David J.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c508t-fae29b364e7b5362af7bca25c11e7f8ed6040a3155590b315366d9e147019ad3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1998</creationdate><topic>Aged</topic><topic>Angioplasty, Balloon, Coronary</topic><topic>Atherectomy, Coronary</topic><topic>Coronary Angiography</topic><topic>Coronary Disease - therapy</topic><topic>Female</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Regression Analysis</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Dauerman, Harold L.</creatorcontrib><creatorcontrib>Higgins, Peter J.</creatorcontrib><creatorcontrib>Sparano, Anthony M.</creatorcontrib><creatorcontrib>Gibson, C.Michael</creatorcontrib><creatorcontrib>Garber, Gary R.</creatorcontrib><creatorcontrib>Carrozza, Joseph P.</creatorcontrib><creatorcontrib>Kuntz, Richard E.</creatorcontrib><creatorcontrib>Laham, Roger J.</creatorcontrib><creatorcontrib>Shubrooks, Samuel J.</creatorcontrib><creatorcontrib>Baim, Donald S.</creatorcontrib><creatorcontrib>Cohen, David J.</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of the American College of Cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Dauerman, Harold L.</au><au>Higgins, Peter J.</au><au>Sparano, Anthony M.</au><au>Gibson, C.Michael</au><au>Garber, Gary R.</au><au>Carrozza, Joseph P.</au><au>Kuntz, Richard E.</au><au>Laham, Roger J.</au><au>Shubrooks, Samuel J.</au><au>Baim, Donald S.</au><au>Cohen, David J.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Mechanical debulking versus balloon angioplasty for the treatment of true bifurcation lesions</atitle><jtitle>Journal of the American College of Cardiology</jtitle><addtitle>J Am Coll Cardiol</addtitle><date>1998-12</date><risdate>1998</risdate><volume>32</volume><issue>7</issue><spage>1845</spage><epage>1852</epage><pages>1845-1852</pages><issn>0735-1097</issn><eissn>1558-3597</eissn><abstract>Objectives. The purpose of this study was to compare the immediate angiographic and long-term results of debulking versus balloon angioplasty for treatment of true bifurcation lesions.
Background. Previous studies have shown true bifurcation lesions to be a high risk morphological subset for percutaneous transluminal coronary angioplasty (PTCA). Although atherectomy devices have been used to treat bifurcation lesions, no studies have compared the outcomes of these alternative treatment modalities.
Methods. Between January 1992 and May 1997, we treated 70 consecutive patients with true bifurcationlesions (defined as a greater than 50% stenosis in both the parent vessel and contiguous side branch) with conventional PTCA (n = 30) or debulking (with rotational or directional atherectomy) plus adjunctive PTCA (n = 40). Paired angiograms were analyzed by quantitative angiography, and clinical follow-up was obtained in all patients.
Results. Acute procedural success was 73% in the PTCA group and 97% in the debulking group (p = 0.01). Major in-hospital complications occurred in two patients in the PTCA group and one in the debulking group. Treatment with atherectomy plus PTCA resulted in lower postprocedure residual stenoses than PTCA alone (16 ± 15% vs. 33 ± 17% in the parent vessel, and 6 ± 15% vs. 39 ± 22% in the side branch; p < 0.001 for both comparisons). At 1 year follow-up, the incidence of target vessel revascularization (TVR) was 53% in the PTCA group as compared with 28% in the debulking group (p = 0.05). Independent predictors of the need for repeat TVR were side branch diameter >2.3 mm, longer lesion lengths, and treatment with PTCA alone.
Conclusions. For the treatment of true bifurcation lesions, atherectomy with adjunctive PTCA is safe, improves acute angiographic results, and decreases target vessel revascularization compared to PTCA alone. The benefits of debulking for bifurcation lesions were especially seen in lesions involving large side branches.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>9857861</pmid><doi>10.1016/S0735-1097(98)00488-4</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Access via ScienceDirect (Elsevier); Alma/SFX Local Collection |
| subjects | Aged Angioplasty, Balloon, Coronary Atherectomy, Coronary Coronary Angiography Coronary Disease - therapy Female Humans Male Middle Aged Regression Analysis Treatment Outcome |
| title | Mechanical debulking versus balloon angioplasty for the treatment of true bifurcation lesions |
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