Early experience with low speed rotational angioplasty

Percutaneous transluminal coronary angioplasty (PTCA) is a surgical technique used in the treatment of coronary arteries that have become blocked by fatty atherosclerotic plaques. In PTCA, a balloon-tipped catheter is inflated at sites of arterial stenosis (narrowing) until the diameter of the vessel is wide enough to allow adequate blood flow to the heart. The technique is usually successful, except in the case of completely occluded (blocked) coronary arteries. PTCA equipment has been amended in attempts to overcome this problem. In low speed rotational angioplasty, a battery-powered electric engine turns a thin drive shaft that runs through the catheter and rotates a rounded tip. The authors describe their initial experiences in using the low speed rotational angioplasty system (ROTACS) to treat 11 patients with complete occlusion or critical stenosis of a coronary artery. None of the patients were candidates for conventional PTCA because of the severity of the arterial lesions. Complete arterial blockages were opened in only two cases, while in another two, the device provided enough support for a guide wire to pass the lesion. In a fifth case, a passage was created for a balloon. In cases where ROTACS was not successful, the lesion was in the right coronary artery or in a curved area of a vessel, and the plaque was often dissected (split) within the artery. Subsequently, three patients were given medical treatment, three patients had coronary bypass surgery, one was symptom-free until angina recurred, and four remained free of symptoms. The study indicates that ROTACS has a low success rate and a high rate of complications. Simpler devices may be more useful. (Consumer Summary produced by Reliance Medical Information, Inc.)