title: Clinical and angiographic outcome of directional atherectomy followed by stent implantation in de novo lesions located at the ostium of the left anterior descending coronary artery.
abstract: BACKGROUND
  Lesions located at the ostium of the left anterior descending coronary artery (LAD) are considered an ideal target for directional atherectomy (DCA), but few data are available about the value of using this strategy before stenting in comparison with stenting alone.
  
  
  OBJECTIVE
  To investigate the immediate and mid term clinical and angiographic results of DCA followed by stent implantation for ostial LAD lesions.
  
  
  METHODS
  Retrospective comparison of the immediate and mid term angiographic and clinical results of a series of 117 consecutive patients with de novo lesions located at the ostium of the LAD. Of these, 46 underwent DCA before stenting and 71 were treated with stenting alone.
  
  
  RESULTS
  Technical success in the two groups was similar at around 98%. DCA plus stenting provided a larger minimum lumen diameter at the end of the procedure than stenting alone (3.57 (0.59) mm v 3.33 (0.49) mm, p = 0.022). There were no differences for in-hospital major adverse events (MACE) (7.5% for atherectomy plus stenting, and 5.3% for stenting alone; p = 0.41). All patients had clinical follow up at a mean of 7.9 (2.7) months. Angiographic follow up was done in 89 patients (76%) at a mean of 5.9 (2.2) months. The atherectomy plus stenting group had a larger minimum lumen diameter than the stenting group (2.79 (0.64) mm v 2.26 (0.85) mm, p = 0.004) and a lower binary restenosis rate (13.8% v 33.3%, p = 0.031). Six month MACE were reduced in the atherectomy plus stenting group (8.7% v 23.9%, p = 0.048).
  
  
  CONCLUSIONS
  Debulking before stenting in de novo lesions located at the ostium of the LAD is safe and is associated with a high rate of technical success. Follow up data show that DCA plus stenting results in a significantly larger minimum lumen diameter and a lower incidence of restenosis than stenting alone.
authors.affiliation: EMO Centro Cuore, Columbus Clinic and Interventional Cardiology Unit, San Raffaele Hospital IRCCS, Milan, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Airoldi
authors.forename: C
authors.initials: C
authors.lastname: Di Mario
authors.forename: G
authors.initials: G
authors.lastname: Stankovic
authors.forename: C
authors.initials: C
authors.lastname: Briguori
authors.forename: M
authors.initials: M
authors.lastname: Carlino
authors.forename: A
authors.initials: A
authors.lastname: Chieffo
authors.forename: F
authors.initials: F
authors.lastname: Liistro
authors.forename: M
authors.initials: M
authors.lastname: Montorfano
authors.forename: P
authors.initials: P
authors.lastname: Pagnotta
authors.forename: V
authors.initials: V
authors.lastname: Spanos
authors.forename: D
authors.initials: D
authors.lastname: Tavano
authors.forename: A
authors.initials: A
authors.lastname: Colombo
mesh_terms: D015906:Angioplasty, Balloon, Coronary; D017225:Atherectomy, Coronary / Q000379:methods*; D003131:Combined Modality Therapy; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D023921:Coronary Stenosis / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging; D011183:Postoperative Complications / Q000000981:diagnostic imaging; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome