Comparative early and nine-month results of rotational atherectomy, stents, and the combination of both for calcified lesions in large coronary arteries

Rainer Hoffmann, Gary S. Mintz, Kenneth M. Kent, Augusto D. Pichard, Lowell F. Satler, Jeffrey J. Popma, Mun K. Hong, John R. Laird, Martin B. Leon

Research output: Contribution to journalArticle

70 Citations (Scopus)

Abstract

The aim of this study was to determine the preferred treatment modality for calcified lesions in large (≤3 mm) coronary arteries, resulting in the largest lumen dimensions and the most favorable late clinical responses. Three hundred six lesions in 306 patients (223 men, mean age 66 ± 11 years) were treated with either rotational atherectomy plus adjunct balloon angioplasty (n = 147), Palmaz-Schartz stents (n = 103), or a combination of rotational atherectomy plus adjunct Palmaz-Schartz stents (n = 56). The procedural success rate was 98.0% to 98.6% for each treatment modality. Minimal lumen diameter (MLD) before therapy was similar for all therapies. Final MLD after combination of rotational atherectomy plus Palmaz-Schartz tents was larger than after stent therapy or rotational atherectomy plus balloon angioplasty (3.21 ± 0.49 mm, 2.88 ± 1.51 mm, and 2.29 ± 0.55 mm, respectively, p <0.0001). Correspondingly, final percent diameter stenosis was lowest after the combination of rotational atherectomy plus stent therapy, and significantly higher for stents or rotational atherectomy plus balloon angioplasty (4.2 ± 15.3%, 14.1 ± 13.3%, and 26.7% ± 16.9%, respectively, p <0.0001). Event-free survival at 9 months was higher for patients treated with the combination of rotational atherectomy plus stents than either stent therapy or rotational atherectomy alone (85%, 77%, and 67%, respectively, log-rank p = 0.0633). The only significant independent predictor of an event during the 9-month follow-up period was the MLD after intervention (odds ratio 0.495, 95% confidence interval 0.308 to 0.796, p = 0.0037). We conclude that preatheroablation using rotational atherectomy, followed by adjunct stent placement for calcified lesions in large arteries, is associated with infrequent complications, the largest acute angiographic results, and the most favorable late clinical event rates.

Original languageEnglish (US)
Pages (from-to)552-557
Number of pages6
JournalAmerican Journal of Cardiology
Volume81
Issue number5
DOIs
StatePublished - Mar 1 1998
Externally publishedYes

Fingerprint

Coronary Atherectomy
Stents
Coronary Vessels
Balloon Angioplasty
Therapeutics
Disease-Free Survival
Pathologic Constriction
Arteries
Odds Ratio
Confidence Intervals

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Comparative early and nine-month results of rotational atherectomy, stents, and the combination of both for calcified lesions in large coronary arteries. / Hoffmann, Rainer; Mintz, Gary S.; Kent, Kenneth M.; Pichard, Augusto D.; Satler, Lowell F.; Popma, Jeffrey J.; Hong, Mun K.; Laird, John R.; Leon, Martin B.

In: American Journal of Cardiology, Vol. 81, No. 5, 01.03.1998, p. 552-557.

Research output: Contribution to journalArticle

Hoffmann, Rainer ; Mintz, Gary S. ; Kent, Kenneth M. ; Pichard, Augusto D. ; Satler, Lowell F. ; Popma, Jeffrey J. ; Hong, Mun K. ; Laird, John R. ; Leon, Martin B. / Comparative early and nine-month results of rotational atherectomy, stents, and the combination of both for calcified lesions in large coronary arteries. In: American Journal of Cardiology. 1998 ; Vol. 81, No. 5. pp. 552-557.
@article{81c129746b46441da71b403d5c452967,
title = "Comparative early and nine-month results of rotational atherectomy, stents, and the combination of both for calcified lesions in large coronary arteries",
abstract = "The aim of this study was to determine the preferred treatment modality for calcified lesions in large (≤3 mm) coronary arteries, resulting in the largest lumen dimensions and the most favorable late clinical responses. Three hundred six lesions in 306 patients (223 men, mean age 66 ± 11 years) were treated with either rotational atherectomy plus adjunct balloon angioplasty (n = 147), Palmaz-Schartz stents (n = 103), or a combination of rotational atherectomy plus adjunct Palmaz-Schartz stents (n = 56). The procedural success rate was 98.0{\%} to 98.6{\%} for each treatment modality. Minimal lumen diameter (MLD) before therapy was similar for all therapies. Final MLD after combination of rotational atherectomy plus Palmaz-Schartz tents was larger than after stent therapy or rotational atherectomy plus balloon angioplasty (3.21 ± 0.49 mm, 2.88 ± 1.51 mm, and 2.29 ± 0.55 mm, respectively, p <0.0001). Correspondingly, final percent diameter stenosis was lowest after the combination of rotational atherectomy plus stent therapy, and significantly higher for stents or rotational atherectomy plus balloon angioplasty (4.2 ± 15.3{\%}, 14.1 ± 13.3{\%}, and 26.7{\%} ± 16.9{\%}, respectively, p <0.0001). Event-free survival at 9 months was higher for patients treated with the combination of rotational atherectomy plus stents than either stent therapy or rotational atherectomy alone (85{\%}, 77{\%}, and 67{\%}, respectively, log-rank p = 0.0633). The only significant independent predictor of an event during the 9-month follow-up period was the MLD after intervention (odds ratio 0.495, 95{\%} confidence interval 0.308 to 0.796, p = 0.0037). We conclude that preatheroablation using rotational atherectomy, followed by adjunct stent placement for calcified lesions in large arteries, is associated with infrequent complications, the largest acute angiographic results, and the most favorable late clinical event rates.",
author = "Rainer Hoffmann and Mintz, {Gary S.} and Kent, {Kenneth M.} and Pichard, {Augusto D.} and Satler, {Lowell F.} and Popma, {Jeffrey J.} and Hong, {Mun K.} and Laird, {John R.} and Leon, {Martin B.}",
year = "1998",
month = "3",
day = "1",
doi = "10.1016/S0002-9149(97)00983-1",
language = "English (US)",
volume = "81",
pages = "552--557",
journal = "American Journal of Cardiology",
issn = "0002-9149",
publisher = "Elsevier Inc.",
number = "5",

}

TY - JOUR

T1 - Comparative early and nine-month results of rotational atherectomy, stents, and the combination of both for calcified lesions in large coronary arteries

AU - Hoffmann, Rainer

AU - Mintz, Gary S.

AU - Kent, Kenneth M.

AU - Pichard, Augusto D.

AU - Satler, Lowell F.

AU - Popma, Jeffrey J.

AU - Hong, Mun K.

AU - Laird, John R.

AU - Leon, Martin B.

PY - 1998/3/1

Y1 - 1998/3/1

N2 - The aim of this study was to determine the preferred treatment modality for calcified lesions in large (≤3 mm) coronary arteries, resulting in the largest lumen dimensions and the most favorable late clinical responses. Three hundred six lesions in 306 patients (223 men, mean age 66 ± 11 years) were treated with either rotational atherectomy plus adjunct balloon angioplasty (n = 147), Palmaz-Schartz stents (n = 103), or a combination of rotational atherectomy plus adjunct Palmaz-Schartz stents (n = 56). The procedural success rate was 98.0% to 98.6% for each treatment modality. Minimal lumen diameter (MLD) before therapy was similar for all therapies. Final MLD after combination of rotational atherectomy plus Palmaz-Schartz tents was larger than after stent therapy or rotational atherectomy plus balloon angioplasty (3.21 ± 0.49 mm, 2.88 ± 1.51 mm, and 2.29 ± 0.55 mm, respectively, p <0.0001). Correspondingly, final percent diameter stenosis was lowest after the combination of rotational atherectomy plus stent therapy, and significantly higher for stents or rotational atherectomy plus balloon angioplasty (4.2 ± 15.3%, 14.1 ± 13.3%, and 26.7% ± 16.9%, respectively, p <0.0001). Event-free survival at 9 months was higher for patients treated with the combination of rotational atherectomy plus stents than either stent therapy or rotational atherectomy alone (85%, 77%, and 67%, respectively, log-rank p = 0.0633). The only significant independent predictor of an event during the 9-month follow-up period was the MLD after intervention (odds ratio 0.495, 95% confidence interval 0.308 to 0.796, p = 0.0037). We conclude that preatheroablation using rotational atherectomy, followed by adjunct stent placement for calcified lesions in large arteries, is associated with infrequent complications, the largest acute angiographic results, and the most favorable late clinical event rates.

AB - The aim of this study was to determine the preferred treatment modality for calcified lesions in large (≤3 mm) coronary arteries, resulting in the largest lumen dimensions and the most favorable late clinical responses. Three hundred six lesions in 306 patients (223 men, mean age 66 ± 11 years) were treated with either rotational atherectomy plus adjunct balloon angioplasty (n = 147), Palmaz-Schartz stents (n = 103), or a combination of rotational atherectomy plus adjunct Palmaz-Schartz stents (n = 56). The procedural success rate was 98.0% to 98.6% for each treatment modality. Minimal lumen diameter (MLD) before therapy was similar for all therapies. Final MLD after combination of rotational atherectomy plus Palmaz-Schartz tents was larger than after stent therapy or rotational atherectomy plus balloon angioplasty (3.21 ± 0.49 mm, 2.88 ± 1.51 mm, and 2.29 ± 0.55 mm, respectively, p <0.0001). Correspondingly, final percent diameter stenosis was lowest after the combination of rotational atherectomy plus stent therapy, and significantly higher for stents or rotational atherectomy plus balloon angioplasty (4.2 ± 15.3%, 14.1 ± 13.3%, and 26.7% ± 16.9%, respectively, p <0.0001). Event-free survival at 9 months was higher for patients treated with the combination of rotational atherectomy plus stents than either stent therapy or rotational atherectomy alone (85%, 77%, and 67%, respectively, log-rank p = 0.0633). The only significant independent predictor of an event during the 9-month follow-up period was the MLD after intervention (odds ratio 0.495, 95% confidence interval 0.308 to 0.796, p = 0.0037). We conclude that preatheroablation using rotational atherectomy, followed by adjunct stent placement for calcified lesions in large arteries, is associated with infrequent complications, the largest acute angiographic results, and the most favorable late clinical event rates.

UR - http://www.scopus.com/inward/record.url?scp=0032031081&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0032031081&partnerID=8YFLogxK

U2 - 10.1016/S0002-9149(97)00983-1

DO - 10.1016/S0002-9149(97)00983-1

M3 - Article

C2 - 9514448

AN - SCOPUS:0032031081

VL - 81

SP - 552

EP - 557

JO - American Journal of Cardiology

JF - American Journal of Cardiology

SN - 0002-9149

IS - 5

ER -