Short-term outcome of percutaneous coronary intervention with directional coronary atherectomy followed by drug-coated b
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ORIGINAL ARTICLE
Short‑term outcome of percutaneous coronary intervention with directional coronary atherectomy followed by drug‑coated balloon: a preliminary report Akihiko Sato1 · Mikihiro Kijima1 · Shohei Ichimura1 · Daiki Yaegashi1 · Fumiya Anzai1 · Takeshi Shimizu1 · Yuko Matsui1 · Hironori Kaneko1 · Keiji Sakamoto1 · Yoshitane Seino1 · Yukio Maruyama1 · Yasuchika Takeishi2 Received: 23 February 2018 / Accepted: 3 July 2018 © The Author(s) 2018
Abstract Directional coronary atherectomy (DCA) is a unique technique used in percutaneous coronary intervention (PCI) which involves the removal of plaque from the coronary artery. Treatment with a drug-coated balloon (DCB) appears to be effective, especially when a predilatation of the lesion is performed appropriately. We hypothesize that the combination therapy of DCA with DCB is an effective strategy in PCI. PCI with DCA followed by DCB was performed for 23 patients from December 2014 to April 2017. All DCA procedures were performed under the guidance of intravascular ultrasound (IVUS) findings and all procedures were successfully performed without incurring major complications such as a coronary perforation. Plaque area (PA) was reduced from 77.3 ± 10.4% at baseline to 50.9 ± 9.2% after DCA and luminal cross-sectional area (CSA) after PCI was enlarged from 3.6 ± 1.8 to 9.3 ± 3.3 mm2. Follow-up coronary angiography (CAG) performed at 6–10 months showed no cases having incurred restenosis. Plaque area at follow-up CAG was 52.0 ± 8.5% and luminal CSA was 9.5 ± 2.1 mm2. There were no cases undergoing target vessel revascularization (TVR) and target lesion revascularization (TLR) during the follow-up periods. PCI with DCA followed by DCB might be an effective strategy for de novo lesions. Keywords Directional coronary atherectomy · Drug-coated balloon · Percutaneous coronary intervention
Introduction Percutaneous coronary intervention (PCI) has been evolving with the emergence of new therapeutic devices since the first PCI was performed by Andrea Gruentzig in 1977, resulting in a continuous improvement in the outcome of PCI procedures for coronary heart disease. Directional coronary atherectomy (DCA), which is a unique technique that involves the removal of plaque from the coronary artery, was first performed in 1990 in the USA with the intent of reducing the abrupt closure and late restenosis rates after plain old balloon angioplasty (POBA). However, the first large * Akihiko Sato [email protected] 1
Department of Cardiology and Vascular Medicine, Hoshi General Hospital, 159‑1 Mukaigawara, Koriyama, Fukushima 963‑8521, Japan
Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
2
randomized clinical trial (CAVEAT) conducted in 1991 failed to demonstrate superiority on the rate of late restenosis in the DCA group compared with the POBA group [1]. Although several clinical trials in the 1990s demonstrated optimal DCA supported by angiographical and intravascular ultrasound (IVUS) findings were superior compared with POBA on
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