Effectiveness of adjunctive stent implantation following directional coronary atherectomy for treatment of left anterior descending ostial stenosis

• Published in: The American journal of cardiology 2002-11, Vol.90 (10), p.1074-1078
• Main Authors: Bramucci, Ezio, Repetto, Alessandra, Ferrario, Maurizio, Canosi, Umberto, Boschetti, Enrico, Brambilla, Nedy, Gnecchi, Massimiliano, Merlini, Piera Angelica, Ardissino, Diego, Angoli, Luigi, Tavazzi, Luigi
• Format: Article
• Language: English
• Subjects: Adult; Aged; Atherectomy, Coronary; Biological and medical sciences; Cardiology; Coronary Artery Disease - diagnostic imaging; Coronary Artery Disease - mortality; Coronary Artery Disease - pathology; Coronary Artery Disease - therapy; Coronary Vessels - pathology; Diseases of the cardiovascular system; Female; Follow-Up Studies; Humans; Italy; Male; Medical sciences; Middle Aged; Prospective Studies; Radiography; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Stents; Surgery; Survival Analysis; Transplants & implants; Treatment Outcome
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/S0002-9149(02)02772-8

The aim of this study was to evaluate the acute and long-term angiographic and clinical results of optimal plaque debulking by means of directional coronary atherectomy (DCA) followed by stent implantation for treatment of left anterior descending (LAD) ostial stenosis. Eighty consecutive patients (66 men; aged 57 ± 10 years) with angina pectoris, documented anterior myocardial ischemia, and de novo LAD ostial stenosis prospectively underwent DCA and stent deployment. They were evaluated angiographically after 6 months and clinically for up to 30 ± 29 months. The primary success rate was 98%. The in-hospital complications were 1 death due to in-stent subacute thrombosis 7 days after the procedure, 1 non–Q-wave myocardial infarction, and 1 retrograde left main artery dissection. The angiographic binary restenosis rate was 14.5%, and the loss index was 0.38 ± 0.35. The target lesion revascularization (TLR) rates at 6, 12, and 24 months were 6.0%, 14.5%, and 16.3%, respectively, and the combined event rates (death, nonfatal myocardial infarction, TLR) at the same times were 8.7%, 17.5%, and 21.2%, respectively. These results indicate that the combined approach of DCA and stent implantation is feasible and safe in patients with LAD ostial lesions, has a high success rate, a low incidence of restenosis, and a good long-term outcome.