Influence of stenotic lesion morphology on immediate and long-term (6 months) angiographic outcome: Comparative analysis of directional coronary atherectomy versus standard balloon angioplasty

Objectives. This study sought to determine whether preprocedural lesion morphology differentially affects the outcome of directional coronary atherectomy versus standard balloon angioplasty. Background. Despite previous studies (Canadian Coronary Atherectomy Trial [CCAT]/Coronary Angioplasty Versus Excisional Atherectomy Trial [CAVEAT]), directional coronary atherectomy continues to be recommended on the basis of lesion-specific features, although the validity of this approach has never been proved. Methods. A retrospective, subgroup analysis of the CCAT data base (group average +/- SD) was performed. Results. In the long term (6 months), both procedures were equally successful in the proximal left anterior descending coronary artery (directional atherectomy 0.62 +/- 0.70 mm vs, coronary angioplasty 0.70 +/- 0.72 mm, p = NS), with atherectomy tending to perform best in relatively ''simple'' lesions (American College of Cardiology/American Heart Association [ACC/AHA] type A: atherectomy 0.57 +/- 0.70 mm vs, angioplasty 0.50 +/- 0.77 mm; ACC/AHA type B-1: atherectomy 0.65 +/- 0.68 mm vs, angioplasty 0.60 +/- 0.68 mm) and those with moderate dystrophic calcification (atherectomy 0.79 +/- 0.56 mm vs, angioplasty 0.45 +/- 0.73 mm), Although greatest minimal lumen diameter gains were seen in larger (>3 mm) coronary arteries (atherectomy 0.76 +/- 0.62 mm vs, angioplasty 0.80 +/- 0.72 mm, p = NS) and those with severe obstruction (preprocedural minimal lumen diameter <1.0 mm: atherectomy 0.80 +/- 0.62 mm vs, angioplasty 0.84 +/- 0.63 mm, p = NS), neither technique was superior, and eccentric stenoses (symmetry index <0.5) had similar outcomes (atherectomy 0.59 +/- 0.39 mm vs, angioplasty 0.62 +/- 0.65 mm, p = NS). Conclusions. These data refute many preconceptions regarding the choice of directional coronary atherectomy on the basis of anatomic criteria.