| Abstrakt: |
The purpose of this study was to evaluate the success rate, complication profile and predictors of outcome of rotational atherectomy (RA) after guidewire crossing of chronic total occlusions (CTO). 145 total occlusions were treated in 139 procedures between 1988 and 1993. Of these, there were 112 single lesion procedures. Compared to pts with non-total occlusions (NTOI, pts with CTO were more likely to be male, younger and have a prior MI, but less likely to present with unstable angina or to have diabetes. Lesions were more likely type C (68.7% vs 15.1%, P<0.0001) and longer (14.8±7.8 vs 8.0±5.6 mm, p<0.0001). Mean baseline stenosis was 100.0%. Post-Rotablator stenosis was 45.6±17.5%. Post-adjunctive balloon stenosis was 24.6±15.9% while final residual stenosis was 26.9±16.8%. The maximum mean burr size was 1.8±0.26 mm while average vessel diameter was 2.74±0.65mm. Success without major complications occurred in 91.0%. Dissection occurred in 18.0%, acute in-lab closure in 3.6%, post-Cath lab reocclusion in 3.6%, emergency bypass surgery on 0%, death in 1.4% and NOMI in 4.3% of pts. Based on 49.2% angiographic follow-up, restenosis occurred in 62.5% of pts. Univariate predictors of RA success were pt age (p=0.02), lesion eccentricity (p=0.04) and vessel diameter (p=0.02). In a multivariable logistic regression model, only larger vessel diameter remained as an independent predictor of success (2.8±0.6 vs 2.0±0.5mm). Older age (p=0.04) and diabetes (p=0.01) were univariate predictors of restenosis. However, in the final multivariable logistic model, only diabetes remained a significant predictor. |
