[Coronary atherectomy using a Rotablator].

A system or rotary atherectomy (Rotablator) was evaluated on coronary stenoses in Man. This device consists of catheter presenting an abrasive olive-shaped knob at one end, and sliding over a central metallic guide, rotating at more than 150,000 tpm. This drill liquifies the atheroma in small microparticles able to cross the microcirculation. The atherectomy surface is perfectly smooth and the risk of thrombosis is minimum. The atherectomy technique is quite simple, similar to PTCA, the balloon being replaced by a drill with a diameter ranging from 1.25 to 2 mm. 48 stenoses in 45 patients were treated with this technique. Twice, the Rotablator's guide was unable to cross the stenosis. In other cases, the stenosis was decreased, in an average, by 75 p. cent (SD 24%) to 43 p. cent (SD 20%) (p less than 0.001). The segment treated is characterized by smooth, linear edges without parictal minithrombi. Complications are most unusual (no deaths, no extended infarction, no emergency bypass related an early reobstruction). The coronary artery may react to the passage of the Rotablator by a spasm; this coronary spasm disappears (sometimes in a few hours) under nitrates derivatives perfusion. The middle term results are very encouraging; in fact, in 19 patients who underwent a control coronary angiography 3 months later, 3 (15%) presented a stenosis. In conclusion, rotary angioplasty is an easy, effective and harmless technique. The exact percentage of re-stenosis remains to be specified in larger series.