Directional Coronary Atherectomy KFSH RC Experience Layth A

Directional Coronary Atherectomy KFSH & RC Experience Layth A. Mimish, J. Buraiki, M. E. Fawzy, Dunn, M. Bakhshi, B. Dajani B.

DCA u 1 st case performed in KFSH in December 1991. Total 149 cases u 21 1992 cases u 35 1993 cases u 38 1994 cases u 52 1995 cases u 3 1996/97 cases

Demographic & Clinical Data u Mean Age 52. 4+-9 years u Males/Females 136/13 u CCS class II-IV 140/149 u History of MI 83(67 QMI( u Restenotic lesions 36

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

DCA u Mean artery size 3+-0. 5 mm u Atherocath sizes 5 6 F 7 F F 75 55 19

Additional procedures u PTCA u Thrombolysis u Stenting u PCPBS 92 4 2 3

Success & Major Comlications u Successful in 142/149 cases (95. 3%( u In 2 patients Atherocath could not be advanced despite predilatation u In 5 patients emergency CABG had to be done, with one mortality post CABG u No QMI

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

6 Months angiographic follow up u Cathetarization performed on 139 of the 142 patients who had successful atherectomy. u Restenoses in 46/139 patients (33%(

Conclusion u DCA is an effective tool for coronary revascularization which carries a high success rate and in large vessels an acceptable restenosis rate u Technically it is more demanding than simple GOBA

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

Percutaneous Revascularization u Initial gain with device u Mechanism of initial gain u Lesion specific device u IVUS u Initial loss (recoil( u Injury and cellular proliferation

Percutaneous Revascularization u Initial gain with device u Mechanism of initial gain u Lesion specific device u IVUS u Initial loss (recoil( u Injury and cellular proliferation