Directional Coronary Atherectomy KFSH - PowerPoint PPT Presentation

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Directional Coronary Atherectomy KFSH

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Title: Directional Coronary Atherectomy KFSH & RC Experience Author: DR.MIMISH Last modified by: Dr. LAYTH MIMISH Created Date: 6/17/1995 11:31:02 PM – PowerPoint PPT presentation

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Title: Directional Coronary Atherectomy KFSH


1
Directional Coronary AtherectomyKFSH RC
Experience
  • Layth A. Mimish, J. Buraiki, M. E. Fawzy,
    B. Dunn, M. Bakhshi, B. Dajani

2
DCA
  • 1st case performed in KFSH in December 1991.
    Total 149 cases
  • 1992 21 cases
  • 1993 35 cases
  • 1994 38 cases
  • 1995 52 cases
  • 1996/97 3 cases

3
Demographic Clinical Data
  • Mean Age 52.4-9 years
  • Males/Females 136/13
  • CCS class II-IV 140/149
  • History of MI 83(67 QMI)
  • Restenotic lesions 36

4
DCA
  • LAD 121
  • Circumflex 9
  • Intermediate 1
  • RCA 18
  • 33 procedures were done to shave dissection flaps
    ( 24 are salvage procedures)

5
DCA
  • Mean artery size 3-0.5mm
  • Atherocath sizes
  • 5 F 19
  • 6F 75
  • 7F 55

6
Additional procedures
  • PTCA 92
  • Thrombolysis 4
  • Stenting 2
  • PCPBS 3

7
Success Major Comlications
  • Successful in 142/149 cases (95.3)
  • In 2 patients Atherocath could not be advanced
    despite predilatation
  • In 5 patients emergency CABG had to be done, with
    one mortality post CABG
  • No QMI

8
Minor Complications
  • Acute occlusion 4
  • Ventricular Fibrillation 1
  • Transient Arrhythmias 2
  • Long dissection 2
  • Haematoma 2
  • Non QMI 13
  • Coronary Embolus 5

9
6 Months angiographic follow up
  • Cathetarization performed on 139 of the 142
    patients who had successful atherectomy.
  • Restenoses in 46/139 patients (33)

10
Conclusion
  • DCA is an effective tool for coronary
    revascularization which carries a high success
    rate and in large vessels an acceptable
    restenosis rate
  • Technically it is more demanding than simple GOBA

11
Debulking Revisited
  • Layth A. Mimish
  • Consultant Cardiologist
  • The Cardiovascular Consultant Group
  • Jeddah, Saudi Arabia

12
Percutaneous Revascularization
  • Initial gain with device
  • Mechanism of initial gain
  • Lesion specific device
  • IVUS
  • Initial loss (recoil)
  • Injury and cellular proliferation

13
Percutaneous Revascularization
  • Initial gain with device
  • Mechanism of initial gain
  • Lesion specific device
  • IVUS
  • Initial loss (recoil)
  • Injury and cellular proliferation
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