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328 Long term clinical outcomes following adjunctive percutaneous transluminal rotational atherectomy during percutaneous stenting procedures in complex native coronary lesions
S181
Abstracts
0.05) and PA behaviors (P ⬍ 0.05), as well as an increase in BG monitoring (P ⬍ 0.05), and foot care activities (P ⬍ 0.05). M CONCLUSION: Based on the results, STEPT plus daily tracking may positively improve self-monitoring behaviors for the prevention of type II diabetes. Canadian Institutes of Health Research (CIHR)
324 THE DISTRIBUTION OF PERIPHERAL ARTERIAL DISEASE IN PATIENTS PRESENTING TO A COMMUNITY CARDIOLOGY CLINIC C Tobin, DW Armstrong, D Brouillard, M Matangi Kingston, Ontario BACKGROUND: Our objective was to determine the prevalence of aorto-iliac disease, total inflow disease, superficial femoral disease and infra-popliteal disease in patients presenting for peripheral arterial disease testing and who were found to have an abnormal ABI. METHODS: PADfile the peripheral arterial disease module of CARDIOfile was searched for all patients with an abnormal ABI (⬍0.95) in one or both lower limbs. There were 1456 studies of which 348 (23.9%) were abnormal. All studies were performed using the 4-cuff method. Aorto-iliac disease was defined when both upper thigh systolic pressures were ⬍20mmHg higher than the highest brachial systolic pressure. Ileo-femoral disease was defined when one upper thigh pressure was ⬍20mmHg higher than the highest brachial systolic pressure. Superficial femoral disease was defined as a low thigh pressure ⬎20mmHg lower than the corresponding upper thigh systolic pressure. Superficial femoral disease could either be unilateral or bilateral. Infra-popliteal disease was defined as when the calf systolic pressure was ⬎20mmHg lower than the corresponding lower thigh systolic pressure. Infra-popliteal disease could also be unilateral or bilateral. RESULTS: See Table 1.
CONCLUSION: In patients with an abnormal ABI, 72.4% have aorto-
iliac disease and 91.8% have aorto-iliac or ileo-femoral disease. 57.5% have infra-popliteal disease and 44% have superficial femoral disease. Canadian Cardiovascular Society (CCS) CCS181 Highlighted Poster PCI: PROCEDURAL CONSIDERATIONS WITH TECHNICAL AND ANTIPLATELET ASPECTS Monday, October 24, 2011 328 LONG TERM CLINICAL OUTCOMES FOLLOWING ADJUNCTIVE PERCUTANEOUS TRANSLUMINAL ROTATIONAL ATHERECTOMY DURING PERCUTANEOUS STENTING PROCEDURES IN COMPLEX NATIVE CORONARY LESIONS EP Merrick, T Martin, M Egred, H Beydoun, S Fort, J Mathers, MP Love Halifax, Nova Scotia BACKGROUND: Revascularization by percutaneous coronary intervention (PCI) has become the predominant mode of symptom relief in patients with ischemic heart disease. However, certain lesion subsets still require surgical revascularization, including those that cannot be successfully crossed or dilated because of a heavy calcium burden. Percutaneous transluminal rotational atherectomy (PTRA) is a technique which can be used to ‘de-bulk’ lesions to assist both balloon dilatation and stent expansion. We retrospectively studied our outcomes when using adjunctive PTRA prior to stent insertion. METHODS: Using institutional and provincial databases, 145 consecutive Nova Scotia patients were identified to have undergone 146 attempted PTRA procedures with stent insertion at our centre between November 2003 and January 2009. Major adverse cardiac events (MACE), comprising death, myocardial infarction (MI) and target vessel revascularization (TVR) were determined at 12 month follow-up. RESULTS: Indications for PTRA included heavily calcified lesions, ostial lesions or prior failure of balloon dilatation. Femoral arterial access predominated (77%). Most cases used 7Fr guides (37%) and combination heparin/glycoprotein IIb/IIIa inhibitor therapy (83%). An average of 2 stents per vessel were deployed, with 57% of cases receiving at least one DES. Average stented length was 39 mm (range 8-137 mm), with a mean stent diameter of 3.0 mm and a final angiographic success rate of 98%. Average procedure time was 114 min (range 37-244 min). There were 4 procedural failures. Three patients died in hospital (2.0%), two of whom required emergency CABG and one who developed refractory CHF. The overall one year MACE rate was 20% (death 6.9%, acute myocardial infarction 4.1% and TVR 7.5%). CONCLUSION: In our experience, PTRA combined with intracoronary stenting in a complex patient cohort, is associated with a high frequency of procedural success and good longterm clinical outcomes.
Abstracts
0.05) and PA behaviors (P ⬍ 0.05), as well as an increase in BG monitoring (P ⬍ 0.05), and foot care activities (P ⬍ 0.05). M CONCLUSION: Based on the results, STEPT plus daily tracking may positively improve self-monitoring behaviors for the prevention of type II diabetes. Canadian Institutes of Health Research (CIHR)
324 THE DISTRIBUTION OF PERIPHERAL ARTERIAL DISEASE IN PATIENTS PRESENTING TO A COMMUNITY CARDIOLOGY CLINIC C Tobin, DW Armstrong, D Brouillard, M Matangi Kingston, Ontario BACKGROUND: Our objective was to determine the prevalence of aorto-iliac disease, total inflow disease, superficial femoral disease and infra-popliteal disease in patients presenting for peripheral arterial disease testing and who were found to have an abnormal ABI. METHODS: PADfile the peripheral arterial disease module of CARDIOfile was searched for all patients with an abnormal ABI (⬍0.95) in one or both lower limbs. There were 1456 studies of which 348 (23.9%) were abnormal. All studies were performed using the 4-cuff method. Aorto-iliac disease was defined when both upper thigh systolic pressures were ⬍20mmHg higher than the highest brachial systolic pressure. Ileo-femoral disease was defined when one upper thigh pressure was ⬍20mmHg higher than the highest brachial systolic pressure. Superficial femoral disease was defined as a low thigh pressure ⬎20mmHg lower than the corresponding upper thigh systolic pressure. Superficial femoral disease could either be unilateral or bilateral. Infra-popliteal disease was defined as when the calf systolic pressure was ⬎20mmHg lower than the corresponding lower thigh systolic pressure. Infra-popliteal disease could also be unilateral or bilateral. RESULTS: See Table 1.
CONCLUSION: In patients with an abnormal ABI, 72.4% have aorto-
iliac disease and 91.8% have aorto-iliac or ileo-femoral disease. 57.5% have infra-popliteal disease and 44% have superficial femoral disease. Canadian Cardiovascular Society (CCS) CCS181 Highlighted Poster PCI: PROCEDURAL CONSIDERATIONS WITH TECHNICAL AND ANTIPLATELET ASPECTS Monday, October 24, 2011 328 LONG TERM CLINICAL OUTCOMES FOLLOWING ADJUNCTIVE PERCUTANEOUS TRANSLUMINAL ROTATIONAL ATHERECTOMY DURING PERCUTANEOUS STENTING PROCEDURES IN COMPLEX NATIVE CORONARY LESIONS EP Merrick, T Martin, M Egred, H Beydoun, S Fort, J Mathers, MP Love Halifax, Nova Scotia BACKGROUND: Revascularization by percutaneous coronary intervention (PCI) has become the predominant mode of symptom relief in patients with ischemic heart disease. However, certain lesion subsets still require surgical revascularization, including those that cannot be successfully crossed or dilated because of a heavy calcium burden. Percutaneous transluminal rotational atherectomy (PTRA) is a technique which can be used to ‘de-bulk’ lesions to assist both balloon dilatation and stent expansion. We retrospectively studied our outcomes when using adjunctive PTRA prior to stent insertion. METHODS: Using institutional and provincial databases, 145 consecutive Nova Scotia patients were identified to have undergone 146 attempted PTRA procedures with stent insertion at our centre between November 2003 and January 2009. Major adverse cardiac events (MACE), comprising death, myocardial infarction (MI) and target vessel revascularization (TVR) were determined at 12 month follow-up. RESULTS: Indications for PTRA included heavily calcified lesions, ostial lesions or prior failure of balloon dilatation. Femoral arterial access predominated (77%). Most cases used 7Fr guides (37%) and combination heparin/glycoprotein IIb/IIIa inhibitor therapy (83%). An average of 2 stents per vessel were deployed, with 57% of cases receiving at least one DES. Average stented length was 39 mm (range 8-137 mm), with a mean stent diameter of 3.0 mm and a final angiographic success rate of 98%. Average procedure time was 114 min (range 37-244 min). There were 4 procedural failures. Three patients died in hospital (2.0%), two of whom required emergency CABG and one who developed refractory CHF. The overall one year MACE rate was 20% (death 6.9%, acute myocardial infarction 4.1% and TVR 7.5%). CONCLUSION: In our experience, PTRA combined with intracoronary stenting in a complex patient cohort, is associated with a high frequency of procedural success and good longterm clinical outcomes.