Document Detail

Plaque removal prior to stent implantation in native coronary arteries: why? When? And how?
MedLine Citation:
PMID:  10212496     Owner:  NLM     Status:  MEDLINE    
Coronary stenting has significantly reduced restenosis in focal de novo coronary lesions, but its impact in complex lesions has been less pronounced. Recent data suggest a possible role for pre-intervention plaque burden in exacerbating neo-intimal hyperplasia after stent implantation. These observations formed the basis for the hypothesis that plaque removal prior to stent implantation, using directional atherectomy in non-calcified lesions and rotational atherectomy in calcified lesions, may reduce restenosis. The currently available non-randomized experience that used this approach has shown its feasibility and favourable long-term outcome when applied in selected patients. However, the incidence of non-Q-wave myocardial infarction is increased with both rotational and directional atherectomy compared to PTCA or stent alone. The utilization of potent antiplatelet agents and/or the development of new atherectomy devices that produce lower embolization rate may decrease the incidence of these ischaemic complications. In addition, considering the increased procedural time and cost, this approach will have to be applied in selected patient subsets where debulking or stenting as a stand-alone strategy is associated with a high restenosis rate. Randomized clinical trials testing the usefulness of this approach, with both rotational and directional atherectomy, are currently in progress.
I Moussa; C Di Mario; A Colombo
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Seminars in interventional cardiology : SIIC     Volume:  3     ISSN:  1084-2764     ISO Abbreviation:  Semin Interv Cardiol     Publication Date:  1998 Jun 
Date Detail:
Created Date:  1999-06-17     Completed Date:  1999-06-17     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  9606070     Medline TA:  Semin Interv Cardiol     Country:  ENGLAND    
Other Details:
Languages:  eng     Pagination:  57-63     Citation Subset:  IM    
Centro Cuore Columbus, Milan, Italy.
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MeSH Terms
Angioplasty, Transluminal, Percutaneous Coronary / methods*
Atherectomy, Coronary*
Coronary Angiography
Coronary Artery Disease / radiography,  surgery*
Recurrence / prevention & control
Retrospective Studies
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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