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Comparison of Directional Coronary Atherectomy-Based Intervention and Stenting Alone in Ostial Lesions of the Left Anterior Descending Artery

Author(s): Chang-Min Chung | Shigeru Nakamura | Osamu Katoh

Journal: Chang Gung Medical Journal
ISSN 2072-0939

Volume: 28;
Issue: 10;
Start page: 689;
Date: 2005;
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Keywords: directional coronary atherectomy | stenting | ostium.

Background: Balloon angioplasty yields suboptimal results and increases the rate ofrestenosis in the ostium of the left anterior descending coronary artery(LAD). Several non-balloon devices have been used to improve the outcomeof dilatation of such lesions.Methods: This investigation retrospectively compared the results of a directionalatherectomy (DCA)-based intervention and stenting alone on the ostiallesions of the LAD, and the effect on the left circumflex artery (LCX)ostium. Sixty-five patients with a successful angioplasty of LAD ostiallesions were studied. Patients were divided into 2 groups: group I (DCA, n =34) and group II (stenting, n = 31).Results: After intervention and at the 3-month follow-up, group I exhibited a largerminimal lumen diameter (MLD), smaller-diameter stenosis, and a lower lossindex than group II. At 6 months, group I showed a lower cumulativerestenosis rate of 32% as compared to 48% for group II (p = 0.04). In groupI, the MLD of the LCX ostium had not changed after DCA or at follow-up.In contrast, the MLD of the LCX was significantly reduced with stentingalone and during follow-up (p < 0.01). The strategy of optimal debulkingplus stenting exhibited a restenosis rate of 9%, in contrast to 33% in the optimaldebulking alone strategy (p = 0.05) after 3 months.Conclusions: During the intervention for LAD ostial lesions, the DCA-based strategyseemed to be superior compared to stenting alone both in terms of acute andlate target lesion revascularization and in terms of the risk of plaque shifting.The best results however were obtained when optimal DCA was combinedwith stenting.

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