Modified technique increases effectiveness of coronary procedure(9-22-99)A modified technique for scraping the plaque off clogged coronary arteries not only reduced the incidence of complications but also decreased the risk of arteries clogging again, said R. Stefan Kiesz, M.D., lead study author from The University of Texas Health Science Center at San Antonio.
Dr. Kiesz, assistant professor of medicine, and his colleagues studied the modified rotablation technique in 111 patients with very hard, calcified coronary blockages. Rotablation is a procedure in which a tiny burr, called a rotablator, is strung through the artery on an extremely tiny wire. The spinning rotablator works like a buzz saw in the artery, chipping away plaque from diseased walls.
"I see a lot of patients who have this form of blockage," Dr. Kiesz said. "Our center is one of the busiest rotablation centers in Texas. We modified the rotablation technique in such a way that we were able to decrease the restenosis rate--the incidence of arteries closing again--to about 26 percent of patients after six months." Restenosis generally occurs in 40 percent to 60 percent of patients with such blockages.
The study is reported in the September issue of Catheterization and Cardiovascular Interventions, a peer-reviewed journal. In the paper, Dr. Kiesz and his co-authors write that the modified technique should be taught to physicians who perform rotablation. The modifications are described in detail in the body of the paper.
"The laundry list for describing what we've done is long, but it includes proper pharmacological preparation of the patient before the procedure, shorter passes with the burr, and a back-and-forth motion," he said. Health Science Center faculty conducted the trial in the interventional cardiology unit of the South Texas Veterans Health Care System, Audie Murphy Division.
Preliminary trial results have been presented at national and international meetings, including the proceedings of the American College of Cardiology. Dr. Kiesz will present the modified technique Sept. 25 at the 11th Transcatheter Cardiovascular Therapeutics (TCT) symposium in Washington, D.C. The rotablator used in the study is made by Boston Scientific.
"The device works beautifully if it is properly used," Dr. Kiesz said. "The person who is doing this procedure should be certified by the company and should be performing a large number of procedures per year to keep his skills up. The procedures should show a high success rate and low complication rate. This is a subspecialty procedure that should be done only by high-volume, experienced operators."
Blockages were successfully treated in more than 98 percent of study patients. Previous studies showed rotablation success rates of 88 percent to 90 percent. Minor complications were reported in fewer than 5 percent of patients, which compared favorably with any previously reported data.
Note: A copy of the study is available from the Office of Public Affairs.Contact: Will Sansom