Low Speed Rotational Angioplasty in Chronic Coronary Artery Obstructions
Between 2/87 and 4/89 low speed rotational angioplasty (RA) was attempted in 60 patients (p). RA was performed with a very flexible stainless steel catheter rotated by an electric motor at a low speed of 200 rpm. After passing the obstruction, further widening was achieved by balloon angioplasty. A total of 60 occlusions (RCA = 46, LAD = 8, CX = 4, ACVB = 2) were attempted. The duration of occlusion estimated from previous myocardial infarction, sudden onset of symptoms or previous angiograms was 1 month (m) to 15 years, mean: 8.2 m. Re-opening with conventional guide wires was always tried prior to RA. If the wire passed the occlusion, p were excluded from the study except for 2, in whom the balloon could not be passed over the wire. In these 2 p, RA was performed over the long wire in place; only after a channel had been created by RA, could the balloon be introduced. In this preselected group of p, success rate was about 60%. Complications comprised 1 emergency surgery due to a dissection of the proximal left coronary artery and subsequent narrowing of the CX during an attempt to reopen the occluded LAD. In 1 p thrombotic material from the RCA was embolized distally without clinical consequences. It is concluded that in chronic coronary artery obstructions which cannot be re-opened by conventional techniques, RA is successful in about 60% and has a low complication rate.