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High‐speed rotational artherectomy (HSRA) was a major advance in percutaneous coronary intervention (PCI) in the early 1990s pre‐stent era. It has been relegated to a “niche” technique by virtue of the advent of superior quality stents and aggressive pharmacologic adjuncts to acute and long‐term management of patients undergoing PCI. This is to say that except for impossibly prohibitive calcified lesions, aggressive balloon angioplasty with stenting and platelet receptor blockers have relegated HSRA to a secondary role in the PTCA armamentarium. Current decrease in late target lesion revascularization (TLR) rates and fewer referrals for CABG may be related not only to aggressive stenting, but to IIb/IIIa glycoprotein inhibition, not to mention the wide spread use of statin drugs. The authors of the current article on HSRA in vessels <3.0 mm diameter, revisit the subject of smaller vessel coronary disease, a persistently unsatisfying element of PCI. The first problem with their analysis is that it is retrospective, as opposed to the time honored prospective randomized trial. The second problem is the mystery of the true reference diameter. What a mixed variety of vessels we have, seeing the QCA of allegedly small vessels, some of which might be so diffusely diseased
Journal of Interventional Cardiology – Wiley
Published: Aug 1, 2003
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