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Directional Coronary Atherectomy KFSH & RC Experience PowerPoint Presentation
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Directional Coronary Atherectomy KFSH & RC Experience

Directional Coronary Atherectomy KFSH & RC Experience

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Directional Coronary Atherectomy KFSH & RC Experience

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  1. Directional Coronary AtherectomyKFSH & RC Experience Layth A. Mimish, J. Buraiki, M. E. Fawzy, B. Dunn, M. Bakhshi, B. Dajani

  2. DCA • 1st case performed in KFSH in December 1991. Total 149 cases • 1992 21 cases • 1993 35 cases • 1994 38 cases • 1995 52 cases • 1996/97 3 cases

  3. Demographic & Clinical Data • Mean Age 52.4+-9 years • Males/Females 136/13 • CCS class II-IV 140/149 • History of MI 83(67 QMI) • Restenotic lesions 36

  4. DCA • LAD 121 • Circumflex 9 • Intermediate 1 • RCA 18 • 33 procedures were done to shave dissection flaps ( 24 are salvage procedures)

  5. DCA • Mean artery size 3+-0.5mm • Atherocath sizes 5 F 19 6F 75 7F 55

  6. Additional procedures • PTCA 92 • Thrombolysis 4 • Stenting 2 • PCPBS 3

  7. Success & Major Comlications • Successful in 142/149 cases (95.3%) • In 2 patients Atherocath could not be advanced despite predilatation • In 5 patients emergency CABG had to be done, with one mortality post CABG • No QMI

  8. Minor Complications • Acute occlusion 4 • Ventricular Fibrillation 1 • Transient Arrhythmias 2 • Long dissection 2 • Haematoma 2 • Non QMI 13 • Coronary Embolus 5

  9. 6 Months angiographic follow up • Cathetarization performed on 139 of the 142 patients who had successful atherectomy. • Restenoses in 46/139 patients (33%)

  10. Conclusion • DCA is an effective tool for coronary revascularization which carries a high success rate and in large vessels an acceptable restenosis rate • Technically it is more demanding than simple GOBA

  11. Debulking Revisited Layth A. Mimish Consultant Cardiologist The Cardiovascular Consultant Group Jeddah, Saudi Arabia

  12. Percutaneous Revascularization • Initial gain with device • Mechanism of initial gain • Lesion specific device • IVUS • Initial loss (recoil) • Injury and cellular proliferation

  13. Percutaneous Revascularization • Initial gain with device • Mechanism of initial gain • Lesion specific device • IVUS • Initial loss (recoil) • Injury and cellular proliferation