Coronary complications of atheroablative devices
- Joseph P Carrozza, MD
Joseph P Carrozza, MD
- Vice President
- Steward Cardiovascular Network
- Professor of Medicine
- Tufts University School of Medicine
Coronary atherectomy (directional, orbital, and rotational) and excimer laser coronary angioplasty account for less than 3 percent of current coronary interventions. The low rate of use is due both to the availability of drug-eluting stents and the lack of compelling trial data suggesting that the atherectomy devices offer better outcomes in a standalone or even an adjunctive role, except in cases where fibrocalcific plaque impedes device delivery or balloon expansion.
Coronary atherectomy and excimer laser angioplasty have all of the adverse events associated with other invasive cardiac procedures, such as coronary angiography and other forms of percutaneous coronary intervention. However, the rates of some of these are increased due to the factors related to both the equipment and the procedure. (See "Complications of diagnostic cardiac catheterization" and "Periprocedural complications of percutaneous coronary intervention".)
The uses and efficacy of these devices are reviewed elsewhere. (See "Specialized revascularization devices in the management of coronary heart disease".)
INCIDENCE OF COMPLICATIONS
A report from the New Approaches to Coronary Intervention (NACI) registry reviewed data from 3265 patients undergoing revascularization with atherectomy devices or laser . There was a 3.6 percent incidence of non-ST elevation (non-Q wave) myocardial infarction (NSTEMI) and 1.1 percent incidence of ST elevation (Q wave) myocardial infarction (STEMI). The in-hospital MI rates were the same for directional atherectomy, extraction atherectomy, rotational atherectomy, and laser. The major etiologies for MI were coronary embolus and abrupt closure.
The true incidence of myocardial infarction (MI) is higher if assessed by more sensitive assays such as three-fold elevations in serum creatine kinase (CK-MB) or troponin concentrations.
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