Objective: To assess the procedural success and complication rates of the first 120 directional coronary atherectomy cases performed at two Toronto hospitals.
Design and setting: Case series in tertiary referral centres.
Patients: One hundred and thirteen patients in whom 120 atherectomy procedures were attempted between July 1990 and April 1992.
Intervention: Directional coronary atherectomy.
Main results: Angiographic success was obtained in 115 of 120 procedures (96%) involving 117 of 123 lesions (95%). Procedural success (angiographic success without death, myocardial infarction or coronary bypass surgery) was obtained in 110 of 120 procedures (92%). Adjunctive balloon angioplasty was required in 20 procedures (17%). There was one death at 36 h in an elderly patient who underwent an emergency procedure while in cardiogenic shock. Periprocedural non-Q wave myocardial infarction occurred in five patients. There were no Q wave myocardial infarctions. Three patients required coronary bypass surgery prior to discharge and vascular complications occurred in five patients.
Conclusions: Directional coronary atherectomy can be performed with procedural success and complication rates comparable to conventional balloon angioplasty. Randomized trials are underway to determine if atherectomy results in a lower restenosis rate.