Transcatheter device synergy: preliminary experience with adjunct directional coronary atherectomy following high-speed rotational atherectomy or excimer laser angioplasty in the treatment of coronary artery disease.

We performed high-speed rotational atherectomy followed by adjunct directional atherectomy in 10 patients and excimer laser angioplasty followed by directional atherectomy in 6 patients and evaluated the results using quantitative coronary arteriography and intravascular ultrasound. Quantitative coronary arteriographic measurements of minimal lumen diameter and % diameter stenosis and intravascular ultrasound measurements of external elastic membrane, lumen, and plaque + media cross-sectional areas; % cross-sectional narrowing; minimal lumen diameter; and target-lesion arc of calcium were made pre-intervention, after rotational atherectomy or excimer laser angioplasty, and after adjunct directional atherectomy. Rotational atherectomy: Using quantitative coronary arteriography, the pre-intervention minimum lumen diameter measured 0.7 +/- 0.4 mm, increased to 1.5 +/- 0.5 mm after rotational atherectomy, and to 2.5 +/- 0.3 mm after adjunct directional atherectomy. The pre-intervention % diameter stenosis measured 78 +/- 15%, decreased to 50 +/- 17% after rotational atherectomy, and to 17 +/- 11% after adjunct directional coronary atherectomy. Intravascular ultrasound showed arcs of target lesion calcification that measured 271 +/- 92 degrees pre-intervention, decreased to 210 +/- 120 degrees after rotational atherectomy, and to 163 +/- 122 degrees after adjunct directional atherectomy, with distinct directional atherectomy cuts into calcium. Pre-intervention, target lesion external elastic membrane area measured 20.4 +/- 2.3 mm2, lumen area measured 1.5 +/- 0.6 mm2, plaque + media are measured 18.9 +/- 2.3 mm2, and % cross-sectional narrowing measured 93 +/- 3.(ABSTRACT TRUNCATED AT 250 WORDS)