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Unstable Angina/Myocardial Infarction/Atherosclerosis: A Multicenter, Randomized Trial of Coronary Angioplasty Versus Directional Atherectomy for Patients With Saphenous Vein Bypass Graft Lesions

Background Directional coronary atherectomy and percutaneous transluminal coronary angioplasty have both been used in symptomatic patients with coronary saphenous vein bypass graft stenoses. The relative merits of plaque excision and removal versus balloon dilatation remain uncertain. We compared ou... Full description

Journal Title: Circulation 1995, Vol.91(7), pp.1966-1974
Main Author: Holmes, David R.
Other Authors: Topol, Eric J. , Califf, Robert M. , Berdan, Lisa G. , Leya, Ferdinand , Berger, Peter B. , Whitlow, Patrick L. , Safian, Robert D. , Adelman, Allan G. , Kellett, Mirle A. , Talley, J. David , Shani, Jacob , Gottlieb, Ronald S. , Pinkerton, Cass A. , Lee, Kerry L. , Keeler, Gordon P. , Ellis, Stephen G.
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Quelle: Copyright © 2013 Lippincott Williams & Wilkins. All rights reserved.
ID: ISSN: 0009-7322
Link: http://ovidsp.ovid.com/ovidweb.cgi?T=JS&NEWS=n&CSC=Y&PAGE=fulltext&D=ovft&AN=00003017-199504010-00014
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title: Unstable Angina/Myocardial Infarction/Atherosclerosis: A Multicenter, Randomized Trial of Coronary Angioplasty Versus Directional Atherectomy for Patients With Saphenous Vein Bypass Graft Lesions
format: Article
creator:
  • Holmes, David R.
  • Topol, Eric J.
  • Califf, Robert M.
  • Berdan, Lisa G.
  • Leya, Ferdinand
  • Berger, Peter B.
  • Whitlow, Patrick L.
  • Safian, Robert D.
  • Adelman, Allan G.
  • Kellett, Mirle A.
  • Talley, J. David
  • Shani, Jacob
  • Gottlieb, Ronald S.
  • Pinkerton, Cass A.
  • Lee, Kerry L.
  • Keeler, Gordon P.
  • Ellis, Stephen G.
ispartof: Circulation, 1995, Vol.91(7), pp.1966-1974
description: Background Directional coronary atherectomy and percutaneous transluminal coronary angioplasty have both been used in symptomatic patients with coronary saphenous vein bypass graft stenoses. The relative merits of plaque excision and removal versus balloon dilatation remain uncertain. We compared outcomes after directional coronary atherectomy or angioplasty in patients with de novo bypass graft stenoses.Methods and Results Fifty-four North American and European sites randomized 305 patients with de novo vein graft lesions to atherectomy (n=149) or angioplasty (n=156). Quantitative coronary angiography at a core laboratory assessed initial and 6-month results. Initial angiographic success was greater with atherectomy (89.2% versus 79.0%), as was initial luminal gain (1.45 versus 1.12 mm, P
language:
source: Copyright © 2013 Lippincott Williams & Wilkins. All rights reserved.
identifier: ISSN: 0009-7322
fulltext: fulltext
issn:
  • 0009-7322
  • 00097322
url: Link


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titleUnstable Angina/Myocardial Infarction/Atherosclerosis: A Multicenter, Randomized Trial of Coronary Angioplasty Versus Directional Atherectomy for Patients With Saphenous Vein Bypass Graft Lesions
creatorHolmes, David R. ; Topol, Eric J. ; Califf, Robert M. ; Berdan, Lisa G. ; Leya, Ferdinand ; Berger, Peter B. ; Whitlow, Patrick L. ; Safian, Robert D. ; Adelman, Allan G. ; Kellett, Mirle A. ; Talley, J. David ; Shani, Jacob ; Gottlieb, Ronald S. ; Pinkerton, Cass A. ; Lee, Kerry L. ; Keeler, Gordon P. ; Ellis, Stephen G.
ispartofCirculation, 1995, Vol.91(7), pp.1966-1974
identifierISSN: 0009-7322
descriptionBackground Directional coronary atherectomy and percutaneous transluminal coronary angioplasty have both been used in symptomatic patients with coronary saphenous vein bypass graft stenoses. The relative merits of plaque excision and removal versus balloon dilatation remain uncertain. We compared outcomes after directional coronary atherectomy or angioplasty in patients with de novo bypass graft stenoses.Methods and Results Fifty-four North American and European sites randomized 305 patients with de novo vein graft lesions to atherectomy (n=149) or angioplasty (n=156). Quantitative coronary angiography at a core laboratory assessed initial and 6-month results. Initial angiographic success was greater with atherectomy (89.2% versus 79.0%), as was initial luminal gain (1.45 versus 1.12 mm, P<.001). Distal embolization was increased with atherectomy (P=.012), and a trend was shown toward more non-Q-wave myocardial infarction (P=.09). Although the 6-month net minimum luminal diameter gain was 0.68 mm for atherectomy and 0.50 mm for angioplasty, the restenosis rates were similar, 45.6% for atherectomy and 50.5% for angioplasty (P=.491). At 6 months, there was a trend toward decreased repeated target-vessel interventions for atherectomy (P=.092); in addition, 13.2% of patients treated with atherectomy versus 22.4% of the angioplasty patients (P=.041) required repeated percutaneous intervention of the initial target lesion.Conclusions Atherectomy of de novo vein graft lesions was associated with improved initial angiographic success and luminal diameter but also with increased distal embolization. There was no difference in 6-month restenosis rates, although primary atherectomy patients tended to require fewer target-vessel revascularization procedures. (Circulation. 1995;91:1966-1974.)
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1Topol, Eric J
2Califf, Robert M
3Berdan, Lisa G
4Leya, Ferdinand
5Berger, Peter B
6Whitlow, Patrick L
7Safian, Robert D
8Adelman, Allan G
9Kellett, Mirle A
10Talley, J. David
11Shani, Jacob
12Gottlieb, Ronald S
13Pinkerton, Cass A
14Lee, Kerry L
15Keeler, Gordon P
16Ellis, Stephen G
titleUnstable Angina/Myocardial Infarction/Atherosclerosis: A Multicenter, Randomized Trial of Coronary Angioplasty Versus Directional Atherectomy for Patients With Saphenous Vein Bypass Graft Lesions
descriptionBackground Directional coronary atherectomy and percutaneous transluminal coronary angioplasty have both been used in symptomatic patients with coronary saphenous vein bypass graft stenoses. The relative merits of plaque excision and removal versus balloon dilatation remain uncertain. We compared outcomes after directional coronary atherectomy or angioplasty in patients with de novo bypass graft stenoses.Methods and Results Fifty-four North American and European sites randomized 305 patients with de novo vein graft lesions to atherectomy (n=149) or angioplasty (n=156). Quantitative coronary angiography at a core laboratory assessed initial and 6-month results. Initial angiographic success was greater with atherectomy (89.2% versus 79.0%), as was initial luminal gain (1.45 versus 1.12 mm, P<.001). Distal embolization was increased with atherectomy (P=.012), and a trend was shown toward more non-Q-wave myocardial infarction (P=.09). Although the 6-month net minimum luminal diameter gain was 0.68 mm for atherectomy and 0.50 mm for angioplasty, the restenosis rates were similar, 45.6% for atherectomy and 50.5% for angioplasty (P=.491). At 6 months, there was a trend toward decreased repeated target-vessel interventions for atherectomy (P=.092); in addition, 13.2% of patients treated with atherectomy versus 22.4% of the angioplasty patients (P=.041) required repeated percutaneous intervention of the initial target lesion.Conclusions Atherectomy of de novo vein graft lesions was associated with improved initial angiographic success and luminal diameter but also with increased distal embolization. There was no difference in 6-month restenosis rates, although primary atherectomy patients tended to require fewer target-vessel revascularization procedures. (Circulation. 1995;91:1966-1974.)
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titleUnstable Angina/Myocardial Infarction/Atherosclerosis: A Multicenter, Randomized Trial of Coronary Angioplasty Versus Directional Atherectomy for Patients With Saphenous Vein Bypass Graft Lesions
authorHolmes, David R. ; Topol, Eric J. ; Califf, Robert M. ; Berdan, Lisa G. ; Leya, Ferdinand ; Berger, Peter B. ; Whitlow, Patrick L. ; Safian, Robert D. ; Adelman, Allan G. ; Kellett, Mirle A. ; Talley, J. David ; Shani, Jacob ; Gottlieb, Ronald S. ; Pinkerton, Cass A. ; Lee, Kerry L. ; Keeler, Gordon P. ; Ellis, Stephen G.
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4Leya, Ferdinand
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6Whitlow, Patrick L.
7Safian, Robert D.
8Adelman, Allan G.
9Kellett, Mirle A.
10Talley, J. David
11Shani, Jacob
12Gottlieb, Ronald S.
13Pinkerton, Cass A.
14Lee, Kerry L.
15Keeler, Gordon P.
16Ellis, Stephen G.
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7Safian, Robert D.
8Adelman, Allan G.
9Kellett, Mirle A.
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11Shani, Jacob
12Gottlieb, Ronald S.
13Pinkerton, Cass A.
14Lee, Kerry L.
15Keeler, Gordon P.
16Ellis, Stephen G.
atitleUnstable Angina/Myocardial Infarction/Atherosclerosis: A Multicenter, Randomized Trial of Coronary Angioplasty Versus Directional Atherectomy for Patients With Saphenous Vein Bypass Graft Lesions
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abstractBackground Directional coronary atherectomy and percutaneous transluminal coronary angioplasty have both been used in symptomatic patients with coronary saphenous vein bypass graft stenoses. The relative merits of plaque excision and removal versus balloon dilatation remain uncertain. We compared outcomes after directional coronary atherectomy or angioplasty in patients with de novo bypass graft stenoses.Methods and Results Fifty-four North American and European sites randomized 305 patients with de novo vein graft lesions to atherectomy (n=149) or angioplasty (n=156). Quantitative coronary angiography at a core laboratory assessed initial and 6-month results. Initial angiographic success was greater with atherectomy (89.2% versus 79.0%), as was initial luminal gain (1.45 versus 1.12 mm, P<.001). Distal embolization was increased with atherectomy (P=.012), and a trend was shown toward more non-Q-wave myocardial infarction (P=.09). Although the 6-month net minimum luminal diameter gain was 0.68 mm for atherectomy and 0.50 mm for angioplasty, the restenosis rates were similar, 45.6% for atherectomy and 50.5% for angioplasty (P=.491). At 6 months, there was a trend toward decreased repeated target-vessel interventions for atherectomy (P=.092); in addition, 13.2% of patients treated with atherectomy versus 22.4% of the angioplasty patients (P=.041) required repeated percutaneous intervention of the initial target lesion.Conclusions Atherectomy of de novo vein graft lesions was associated with improved initial angiographic success and luminal diameter but also with increased distal embolization. There was no difference in 6-month restenosis rates, although primary atherectomy patients tended to require fewer target-vessel revascularization procedures. (Circulation. 1995;91:1966-1974.)
pub© 1995 American Heart Association, Inc.
date1995-04