Does Adjuvant Stenting After Coronary Rotablation Affect Restenosis Rate ! Layth A. Mimish, M. Bakhshi, J. Buraiki, A. Patel, K. Niazi, M. E. Fawzy, B. Dajani, B. Dunn K.F.S.H. & R.C. Riyadh, Saudi Arabia 1 1 1 1

The Goal of The Study Retrospective analysis of all cases who underwent conary revascularization with high speed rotational atherectomy from October 1993 - October 1997 Comparison of angiographic restenosis rates between patients who had HSRA +ballooning, and those who had additional stenting at the end of the procedure 2 2 2 2

Indications of Rotablation Calcification in the coronary lesion on floroscopy Inability to dilate with high atmospheric pressures Inability to cross the lesion with 1.5 mm balloon Participation in the Effect of Debulking on Restenoses Study (EDRESS) 3 3 3 3

Indications of Stenting Coronary dissection unresolved by prolonged balloon inflaton Residual stenosis more than 40% Part of the EDRESS protocol 4 4 4 4

Rotablation 10,000 U IV Heparin before procedure Small Burr Size with larger Burrs if needed Multiple short passes No significant drop in RPM Multiple doses of I.C. NTG and Verapamil Ballooning in all cases 5 5 5 5

Stenting Ticlopidine 250 mg ACT 250-300 14-16 Atmospheres deployment pressure Multiple post deployment angiographic views Sheath removal within 3 hrs. Ticlopidine BID, ASA for 1 month 6 6 6 6

Demographic Data October 1993-1997, 183 cases 147 males and 36 females Mean age 57+-11 years LAD 102, Diagonal 2, Intermediate 2, Circumflex/OM 27, RCA 50 cases Lesion type B-C 84% Stenting in 72 cases 7 7 7 7

Rotablation Mean Burr Size 1.9 +- 0.3 mm Mean number of passes 4+-2 Ablation time 99+-59 sec All lesion were dilated with a balloon post HSRA Success rate 95% 8 8 8 8

Demographic &clinical data Rotablation Rota+Stenting No. 109 Age 58.5+-10 M/F 82/27 Hx MI 55/109 QMI 40/55 Hx PTCA 40/109 73 55.3+-11 63/10 48/73 43/48 11/73 9 9 9

Demographic &clinical data Rotablation Rota+Stenting LAD 64/109 36/73 Cx/OM 16/109 8/73 RCA 24/109 27/73 Total Occlusion 22/109 9/73 Size 2.9+-0.5 3.2+-0.3 Type A 24 29 Type B 76 24 Type C 9 20 10 10 10

Demographic &clinical data Rotablation Rota+Stenting Burr size 1.8+-0.3 No. Burrs 1.2+-0.5 No. Passes 3.5+-1.7 Ablation 84+-46 Ca ++ 69 Failed Balloon 9 2.1+-0.3 1.2+-0.5 3.5+-1.7 126+-63 26 3 11 11 11

Demographic &clinical data Rotablation Rota+Stenting Success 101(93%) Failure 8 Death 2 (1.8%) Acute MI 2 CABG 4 Dissection 17 Non QMI 3 72(98.6%) 3 1 6 12 12 12

6 Months Angiographic follow up Available on 90% of patients who completed 6 months after the procedure Restenoses in the total group was 38.7% Restenoses in the stented group was 34.3% Restenoses in the non-stented group was 42.5% 13 13 13 13

Conclusion There was 12.9% reduction in restenoses in stented group Total numbers were small Mean vessel size was larger than average Restenoses remains high even with stenting 14 14 14 14