Author + information
- Received January 17, 1995
- Revision received August 31, 1995
- Accepted October 11, 1995
- Published online March 1, 1996.
- Brian P. Kimball, MD, FRCPC∗,
- Eric A. Cohen, MD, FRCPC,
- Allan G. Adelman, MD, FRCPC, FACC,
- Canadian Coronary Atherectomy Trial Investigators
- ↵∗Address for correspondence: Dr. Brian P. Kimball, The Toronto Hospital (General Division) 300 Elizabeth Street EN 11-216, Toronto, Ontario M5G 2C4, Canada.
Objectives. This study sought to determine whether preprocedural lesion morphology differentially affects the outcome of directional coronary atherectomy versus standard balloon angioplasty.
Background. Despite previous studies (Canadian Coronary Atherectomy Trial [CCAT]/Coronary Angioplasty Versus Excisional Atherectomy Trial [CAVEAT]), directional coronary atherectomy continues to be recommended on the basis of lesion-specific features, although the validity of this approach has never been proved.
Methods. A retrospective, subgroup analysis of the CCAT data base (group average ± SD) was performed.
Results. In the long term (6 months), both procedures were equally successful in the proximal left anterior descending coronary artery (directional atherectomy 0.62 ± 0.70 mm vs. coronary angioplasty 0.70 ± 0.72 mm, p = NS), with atherectomy tending to perform best in relatively “simple” lesions (American College of Cardiology/American Heart Association [ACC/AHA] type A: atherectomy 0.57 ± 0.70 mm vs. angioplasty 0.50 ± 0.77 mm; ACC/AHA type B1: atherectomy 0.65 ± 0.68 mm vs. angioplasty 0.60 ± 0.68 mm) and those with moderate dystrophic calcification (atherectomy 0.79 ± 0.56 mm vs. angioplasty 0.45 ± 0.73 mm). Although greatest minimal lumen diameter gains were seen in larger (>3 mm) coronary arteries (atherectomy 0.76 ± 0.62 mm vs. angioplasty 0.80 ± 0.72 mm, p = NS) and those with severe obstruction (preprocedural minimal lumen diameter < 1.0 mm: atherectomy 0.80 ± 0.62 mm vs. angioplasty 0.84 ± 0.63 mm, p = NS), neither technique was superior, and eccentric stenoses (symmetry index < 0.5) had similar outcomes (atherectomy 0.59 ± 0.49 mm vs. angioplasty 0.62 ± 0.65 mm, p = NS).
Conclusions. These data refute many preconceptions regarding the choice of directional coronary atherectomy on the basis of anatomic criteria.
☆ This study was supported by a grant from the Medical Research Council of Canada, Ottawa and by Devices for Vascular Interventional. Redwood City and Advanced Cardiovascular Systems. Temecula, California. A complete list of participating investigators and institutions for the Canadian Coronary Atherectomy Trial appears in reference 9.
- Received January 17, 1995.
- Revision received August 31, 1995.
- Accepted October 11, 1995.