Directional coronary atherectomy - The initial experience at Chang Gung Memorial Hospital

Directional coronary atherectomy (DCA) using Simpson's ArthroCath device was performed in 17 patients for 19 atherosclerotic lesions (18 in the left anterior descending artery and 1 in the right coronary artery). The diameter of coronary artery ranged from 2.5 to 3.7 mm (mean, 3.3 ± 0.3 mm), and the lesion length ranged from 5 to 15 mm (mean, 9.4 ± 0.8 mm). All lesions were proximal and readily accessible, and were resected successfully. The mean luminal diameter stenosis was reduced from 86.9 ± 8.7% to 17.1 ± 8.4% after the procedure. There was no mortality. None of the patients had acute occlusion of the vessels treated. Six instances of complications, one major and five minor, occurred in five patients. The major complication was not directly related to the DCA procedure, but occurred in a patient who received balloon angioplasty to a distal left anterior descending artery lesion immediately after an uneventful DCA for a proximal lesion. The angioplasty resulted in artery perforation caused by balloon rupture. The patient was given emergency coronary artery bypass surgery. Five minor complications included side branch occlusion in two (one of these resulted in non-Q infarction), and silent non-Q infarction in three. The patients' minor complications were clinically uneventful. Therefore, clinical success was obtained in 95% (18/19) of DCA procedures. In conclusion, preliminary experience indicates that DCA is a safe and effective coronary intervention procedure in selected patients with discrete, non-calcified lesions in large proximal or mid-coronary vessels.