1. 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

2. The Goal of The Study
Retrospective analysis of all cases who underwent conary revascularization with high speed rotational atherectomy from October 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

3. 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

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

5. 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

6. 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

7. Demographic Data October 1993-1997, 183 cases 147 males and 36 females
Mean age 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

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

9. Demographic &clinical data Rotablation Rota+StentingNo
Age
M/F /27
Hx MI /109
QMI /55
Hx PTCA /109 73
63/10
48/73
43/48
11/73 9 9 9

10. Demographic &clinical data Rotablation Rota+Stenting
LAD / /73
Cx/OM / /73
RCA / /73
Total Occlusion / /73
Size
Type A
Type B
Type C 10 10 10

11. Demographic &clinical data Rotablation Rota+Stenting
Burr size
No. Burrs
No. Passes
Ablation Ca
Failed Balloon 26 3 11 11 11

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

13. 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

14. 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