Coronary Angioplasty Versus Excisional Atherectomy Trial II - CAVEAT II

Description:

Directional atherectomy vs. PTCA for adverse event in patients with SVGs.

Hypothesis:

To compare directional atherectomy with balloon angioplasty in saphenous vein grafts.

Study Design

Study Design:

Patients Screened: Not given
Patients Enrolled: 305

Patient Populations:

De novo saphenous vein graft lesions
Significant stenosis between 60-100%
Suitable for either PTCA or DCA

Primary Endpoints:

Repeat procedures

Secondary Endpoints:

Angiographic restenosis

Drug/Procedures Used:

Directional atherectomy (DCA) vs. balloon angioplasty (PTCA)

Concomitant Medications:

Aspirin, heparin, calcium channel blockade

Principal Findings:

Initial procedural success higher for DCA (89.2%) compared to PTCA (79.0%), with larger luminal gains (1.45mm vs 1.12mm).

Early complications were more frequent with DCA. Distal embolization was significantly higher (p = 0.012) for the DCA group (13.4%) compared to the PTCA group (5.1%). Rates of non-Q wave MI were also higher for the DCA group (16.1% vs 9.6%), although this trend was not statistically significant.

At six months, there was no significant difference in the need for repeat procedures (13.2% DCA vs 22.4% PTCA) or in restenosis rates (45.6% DCA vs 50.5% PTCA).

Interpretation:

As in CAVEAT I, directional atherectomy was associated with higher initial complication rates, with no significant long-term clinical benefit over angioplasty.

References:

1. Circulation 1995;91:1966-74. Final results

Clinical Topics: Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Aortic Surgery

Keywords: Myocardial Infarction, Atherectomy, Coronary, Saphenous Vein, Coronary Disease, Constriction, Pathologic, Angioplasty, Balloon, Coronary


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