Treatment of complex and “undilatable” coronary stenosis using rotational atherectomy with adjunctive or complementary balloon angioplasty

We studied 32 patients who had complex lesions or morphologic characteristics associated with poor outcome utilizing conventional PTCA, such as ostial stenosis, calcified lesions, long or diffuse lesions, restenotic lesions or lesions which can not be crossed or dilated with a balloon. These 32 patients underwent 72 procedures in which rotational atherectomy and adjunctive or complementary PTCA were performed in 33 vessels to treat 50 lesions. They were mainly (87.5%) in the left anterior descending coronary artery. According to modified ACC/AHA lesion classification, there were 19 type B2 lesions (38.0%) and 31 type C lesions (62.0%). Plain balloon angioplasty was also performed in additional 22 lesions. Of the 32 patients, 19 were male and 13 female. Their ages ranged from 42 to 79 years. The majority presented with Canadian Cardiovascular Society angina class III or IV. The left ventricular ejection fraction was 50% in 17 patients (53.1%), 30-50% in 10 patients (31.3%) and 30% in 5 patients (15.6%). In 3 patients rotational atherectomy was performed with the aid of intra-aortic balloon pumping for hemodynamic stabilization. Single vessel disease was present in 7 patients (21.9%), double vessel disease in 19 patients (59.4%) and triple vessel disease in 6 patients (18.7%). Angiographic and procedural success rates were 100%. However, largely, success criteria was achieved after adjunctive or complementary PTCA had been performed. Complex and “undilatable” coronary stenosis may be treated with rotational atherectomy and adjunctive or complementary PTCA.