Document Detail

Debulking of chronic coronary total occlusions with rotational or directional atherectomy before stenting: Final results of DOCTORS study.
MedLine Citation:
PMID:  18023899     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To evaluate the safety and efficacy of pre-stent plaque debulking strategy for percutaneous coronary intervention for CTO. BACKGROUND: Drug-eluting stents (DES) reduce lesion recurrence after percutaneous coronary intervention for chronic total occlusion (CTO). However, massive plaque burden or calcified plaque sometime hinders optimal stenting. The aim of the study was to investigate the safety and the effectiveness of pre-stent plaque debulking in CTOs. The primary end-point was the angiographic restenosis rate at 6 months. Secondary end-points were the major adverse cardiac event (MACE) at 30 days and at 1 year. METHOD: Between October 2000 and July 2003, 266 patients with CTOs were evaluated in 21 Japanese centers. After successful wire crossing, an operator judged the indications for a debulking strategy (177 patients for rotational and 89 for directional atherectomy). The subjects were then randomly assigned to a debulking (rotational: 90, directional: 48) or non-debulking (rotational: 87, directional: 41) group. RESULT: Baseline clinical and lesion characteristics showed no differences between the groups. The debulking group tended to have the higher 30-day MACE rate than the non-debulking group (15.9% vs 8.5%, P=0.07). Although binary 6 month restenosis rates did not reach statistical significance (debulking 23.8% vs non-debulking 34.6%; P=0.072), the 1-year MACE rate was lower in the debulking group than in the non-debulking group (27.5% vs 39.8%; P=0.033). CONCLUSION: This study demonstrated that pre-stent plaque debulking of CTO was associated with a favorable mid-term outcome with lower target revascularization rate in the debulking group than in the non-debulking group.
Etsuo Tsuchikane; Takahiko Suzuki; Yasushi Asakura; Hirotaka Oda; Kinzo Ueda; Takahiro Tanaka; Tetsuo Matsubara; Yung-Sheng Hsu; Hideo Tamai; Osamu Katoh;
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Publication Detail:
Type:  Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2007-11-19
Journal Detail:
Title:  International journal of cardiology     Volume:  125     ISSN:  1874-1754     ISO Abbreviation:  Int. J. Cardiol.     Publication Date:  2008 Apr 
Date Detail:
Created Date:  2008-03-31     Completed Date:  2008-05-07     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8200291     Medline TA:  Int J Cardiol     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  397-403     Citation Subset:  IM    
Department of Cardiology, Toyohashi Heart Center, 21-1, Gobudori, Ohyama, Toyohashi, Aichi 441-8530, Japan.
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MeSH Terms
Atherectomy, Coronary / adverse effects,  methods*
Chronic Disease
Coronary Angiography
Coronary Occlusion / therapy*
Coronary Restenosis / radiography
Coronary Thrombosis / complications
Middle Aged
Myocardial Infarction / complications
Prospective Studies
Shock, Cardiogenic / complications
Ultrasonography, Interventional
Kenshi Fujii / ; Hideo Nishikawa / ; Yuji Hamazaki / ; Koji Oku / ; Takatoshi Hayashi / ; Yoshinori Yasaka / ; Mikihiro Kijima / ; Tadanori Aizawa / ; Satoru Sumitsuji / ; Mitsugu Hirokami / ; Hiroaki Hosokawa / ; Eiji Nozaki / ; Kenji Tamaki / ; Takaaki Isshiki / ; Ken Kozuma /

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