1. Directional Coronary Atherectomy KFSH & RC Experience Layth A. Mimish, J. Buraiki, M. E. Fawzy, B. Dunn, M. Bakhshi, B. Dajani

2. DCA u 1st case performed in KFSH in December 1991. Total 149 cases u 1992 21 cases u 1993 35 cases u 1994 38 cases u 1995 52 cases u 1996/97 3 cases

3. Demographic & Clinical Data u Mean Age 52.4+-9 years u Males/Females 136/13 u CCS class II-IV 140/149 u History of MI 83(67 QMI) u Restenotic lesions 36

4. DCA u LAD 121 u Circumflex 9 u Intermediate 1 u RCA 18 u 33 procedures were done to shave dissection flaps ( 24 are salvage procedures)

5. DCA u Mean artery size 3+-0.5mm u Atherocath sizes 5 F 19 5 F 19 6F 75 6F 75 7F 55 7F 55

6. Additional procedures u PTCA 92 u Thrombolysis 4 u Stenting 2 u PCPBS 3

7. Success & Major Comlications u Successful in 142/149 cases (95.3%) u In 2 patients Atherocath could not be advanced despite predilatation u In 5 patients emergency CABG had to be done, with one mortality post CABG u No QMI

8. Minor Complications u Acute occlusion 4 u Ventricular Fibrillation 1 u Transient Arrhythmias 2 u Long dissection 2 u Haematoma 2 u Non QMI 13 u Coronary Embolus 5

9. 6 Months angiographic follow up u Cathetarization performed on 139 of the 142 patients who had successful atherectomy. u Restenoses in 46/139 patients (33%)

10. Conclusion u DCA is an effective tool for coronary revascularization which carries a high success rate and in large vessels an acceptable restenosis rate u Technically it is more demanding than simple GOBA

11. Debulking Revisited Layth A. Mimish Consultant Cardiologist The Cardiovascular Consultant Group Jeddah, Saudi Arabia Jeddah, Saudi Arabia

12. Percutaneous Revascularization u Initial gain with device u Mechanism of initial gain u Lesion specific device u IVUS u Initial loss (recoil) u Injury and cellular proliferation

13. Percutaneous Revascularization u Initial gain with device u Mechanism of initial gain u Lesion specific device u IVUS u Initial loss (recoil) u Injury and cellular proliferation