Directional Coronary Atherectomy KFSH

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Directional Coronary AtherectomyKFSH RC
Experience

• Layth A. Mimish, J. Buraiki, M. E. Fawzy,
  B. Dunn, M. Bakhshi, B. Dajani

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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

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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

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DCA

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

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DCA

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

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Additional procedures

• PTCA 92
• Thrombolysis 4
• Stenting 2
• PCPBS 3

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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

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Minor Complications

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

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6 Months angiographic follow up

• Cathetarization performed on 139 of the 142
  patients who had successful atherectomy.
• Restenoses in 46/139 patients (33)

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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

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Debulking Revisited

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

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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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Percutaneous Revascularization

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