[Preliminary experience in the treatment of complex stenosis in the aged (> or = 70 years) with high-speed rotational atherotomy followed by conventional PTCA].

Rotational coronary atherectomy with adjunctive balloon angioplasty was performed in 36 patients older than 70 years. Previous myocardial infarction, coronary angioplasty and coronary artery bypass were present in 44%, 11% and 14%, respectively. Thirty-six percent and 33% of patients presented stable and unstable angina pectoris, respectively. Totally, 46 lesions were treated (1,3 lesion/patient). All lesions had complex morphology characteristics: eccentricity (63%), calcification (69%), angulation (44%), length > 10 mm (11%), undilatable rigid lesion with failed PTCA (11%), ostial disease (9%), ulceration (7%). In 39% was present a single-vessel disease, in 44% double-vessel disease and in 17% triple-vessel disease. Five patients received rotational atherectomy on two stenoses in the same vessel, 5 received a two vessels treatment. Procedure was successful in 94% of patients; 2 patients (6%) had major complication (1 urgent coronary artery bypass and 1 acute myocardial infarction) without any death. All patients with successful rotational atherectomy had repeated coronary angiography at 24 hours. No patient showed significant deterioration (stenosis > or = 50%) of the initial result at 24 hours. Rotational atherectomy can be performed in patients over 70 years with complex coronary lesions with a high success rate, low complications and persistence at 24 hours of initial gain. It should be considered as a primary therapeutical option in selected cases with complex coronary lesions in which conventional PTCA can be unsuccessful.