• Directional (DCA)
• Rotational (Rotablator)
• Excimer Laser Angioplasty (ELCA)
• Other devices

ACC 2002 Meeting Coverage

TCT 2002 Abstracts

• Atheroablative Techniques

Mechanisms of acute gain and late lumen loss after atherectomy in different preintervention arterial remodeling patterns
Oikawa Y, et al. 
Am J Cardiol 2002;89:505-10.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11867032
Coronary artery restenosis after atherectomy was primarily due to an increase in plaque in the positive and/or intermediate remodeling groups. However, in the negative remodeling group, late lumen loss might have been caused by both an increase in plaque and vessel shrinkage.

Images in cardiology
Microscopic evidence of effective ablation of calcium and metal from coronary arteries treated with directional coronary atherectomy using the Flexicut device 
Ribichini F, et al. 
Heart 2002;87:283.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11847178
http://heart.bmjjournals.com/cgi/content/full/87/3/283

Relation of matrix-metalloproteinase 3 found in coronary lesion samples retrieved by directional coronary atherectomy to intravascular ultrasound observations on coronary remodeling 
Schoenhagen P, et al. 
Am J Cardiol 2002;89:1354-9.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=12062727
In this in vivo intravascular ultrasound and histologic study, increased cell-associated MMP-3 staining was associated with positive arterial remodeling.

Role of plaque proliferation in late lumen loss after directional coronary atherectomy 
Sumitsuji S, et al. 
Circ J 2002;66:362-6.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11954950
The mechanism of late lumen loss after DCA consists of both arterial remodeling and plaque proliferation, and the residual %PA after the procedure determines the subsequent lumen loss. With a lower %PA, a change in the plaque area (PA) contributes more to late lumen loss than do changes in vessel area (VA). With a high %PA, a change in the VA contributes more to late lumen loss.

Comparison of dilatation mechanism and long-term vessel remodeling between directional coronary atherectomy and balloon angioplasty assessed by volumetric intravascular ultrasound 
Suzumura H, et al. 
J Invasive Cardiol 2002;14:315-20.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=12042623
There were some differences in mechanism of dilatation and time course of change in vessel size between DCA and POBA patients. The principal mechanism was vessel stretching and longitudinal plaque redistribution in the POBA group and plaque debulking in the DCA group. In the POBA group, vessel volume increased just after the procedure; this increase was maintained at 6 months and at > 1-year. However, in the DCA group, vessel volume increased initially 6 months after the procedure. 3-D IVUS revealed a difference in mechanism of dilatation between POBA and DCA; this difference might affect late-term vessel remodeling even in patients without restenosis

Rotational Atherectomy                        Archive 1986-2001

Device selection in the treatment of in-stent restenosis with and without radiation (from the Gamma Radiation Trials)  
Ajani AE, et al. 
Am J Cardiol 2002;89:137-44.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11792331
The overall recurrence rate of ISR was lower in patients treated with gamma radiation using iridium-192 compared with placebo. Device selection did not influence late clinical outcomes in irradiated and nonirradiated groups.

Influence of device selection on angiographic outcomes for the treatment of in-stent restenosis. A sub analysis from the Washington Radiation for In-Stent restenosis Trial (WRIST) 
Zimarino M, et al. 
Ital Heart J 2002;3:256-62.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=12025375
Intracoronary brachytherapy (ICB), reduces the recurrence of in-stent restenosis through a reduction in late loss. In view of the higher risk of delayed thrombosis, additional stenting, either alone or followed by ICB, should be used with caution

Rotablator versus cutting balloon for the treatment of long in-stent restenoses 
Braun P, et al. 
J Invasive Cardiol 2002;14:291-6.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=12042616  
Even when the methodological constraints of retrospective studies are taken into account, the study data indicate that treating diffuse ISR with the CB results in an acceptable long-term outcome and a low complication rate, results which make this method appear superior to RA.

Mechanisms of myocardial hypoperfusion during rotational atherectomy of de novo coronary artery lesions and stenosed coronary stents: Insights from serial myocardial scintigraphy 
Koch KC, et al. 
J Nucl Cardiol 2002;9:304-11.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=12032478
http://www.mosby.com/scripts/om.dll/serve?action=searchDB&searchDBfor=art&artType=abs&id=a120363&target=
Incidence, extent, and severity of rotablation-related transient hypoperfusion are influenced by neither the type nor the quantity of ablated plaque material. Thus embolization of ablated plaque may be less important compared with other factors such as microcavitation or platelet aggregation.

Rotational atherectomy does not reduce recurrent in-stent restenosis: results of the angioplasty versus rotational atherectomy for treatment of diffuse in-stent restenosis trial (ARTIST) 
vom Dahl J, et al. 
Circulation 2002;105:583-8.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11827923
http://www.circulationaha.org/cgi/content/full/105/5/583
http://www.circulationaha.org/cgi/content/abstract/105/5/583
In terms of the primary objective of the study, PTCA produced a significantly better long-term outcome than ROTA followed by adjunctive low-pressure PTCA.

Excimer Laser Angioplasty (ELCA)                        Archive 1983-2001

Device selection in the treatment of in-stent restenosis with and without radiation (from the Gamma Radiation Trials)  
Ajani AE, et al. 
Am J Cardiol 2002;89:137-44.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11792331  
The overall recurrence rate of ISR was lower in patients treated with gamma radiation using iridium-192 compared with placebo. Device selection did not influence late clinical outcomes in irradiated and nonirradiated groups.

Laser angioplasty and laser-induced thrombolysis in revascularization of anomalous coronary arteries 
Shah R, et al. 
J Invasive Cardiol 2002;14:180-6.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11923571  
Full text journal article Apr 2002
Laser Angioplasty and Laser-Induced Thrombolysis in Revascularization of Anomalous Coronary Arteries
The use of excimer laser angioplasty in acute coronary patients with anomalous arteries may improve clinical outcomes.

Other Devices                        Archive 1983-2001

[Pullback atherectomy. An alternative procedure in the treatment of coronary stenosis and in-stent restenosis] 
Lins M, et al. 
Z Kardiol 2002;91:40-8.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11963206
With the pullback atherectomy catheter, a safe and effective alternative device is available for the treatment of coronary lesions and also of in-stent restenosis. Promising short and acceptable long-term results are comparable to those of other debulking procedures.