Randomized comparison of debulking followed by stenting versus stenting alone for ostial left anterior descending artery stenosis: intravascular ultrasound guidance.
BACKGROUND
Although directional coronary atherectomy (DCA) before stenting has the advantage of combining substantial removal of atheromatous plaque and prevention of elastic recoil, there has been no randomized study to investigate its efficacy in ostial left anterior descending artery (LAD) lesions. This study was aimed to evaluate the effect of DCA followed by stenting on ostial LAD stenosis under the guidance of intravascular ultrasound (IVUS).


METHODS
Eighty-six patients with ostial LAD stenoses were randomly assigned to DCA followed by stenting (group I) or stenting alone (group II). Aggressive DCA or optimal stenting was performed in both groups under the guidance of IVUS. The primary end point was angiographic restenosis at 6 months.


RESULTS
Baseline clinical and angiographic characteristics were similar between the 2 groups. The postprocedural minimal lumen diameter was larger in group I than group II (4.0 +/- 0.4 mm vs. 3.5 +/- 0.5 mm, P <.001). However, the angiographic restenosis rates were not significantly different between the 2 groups (9/32 [28.1%] in group I vs. 11/30 [36.7%] in group II, P =.472). The postprocedural IVUS stent area was the only independent determinant of restenosis by multivariate analysis (odds ratio.61, 95% CI 0.41-0.92, P =.018).


CONCLUSIONS
DCA followed by stenting achieved greater lumen gain than stenting alone for ostial LAD stenosis. However, DCA did not improve angiographic restenosis.
Department of Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Young-Hak
YH
Kim
Myeong-Ki
MK
Hong
Seung-Whan
SW
Lee
Cheol Whan
CW
Lee
Ki Hoon
KH
Han
Jae-Joong
JJ
Kim
Seung-Wook
SW
Park
Gary S
GS
Mintz
Seung-Jung
SJ
Park
D015906:Angioplasty, Balloon, Coronary; D000925:Anticoagulants / Q000627:therapeutic use; D017225:Atherectomy, Coronary; D003131:Combined Modality Therapy; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D003331:Coronary Vessels / Q000000981:diagnostic imaging; D005260:Female; D005500:Follow-Up Studies; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015607:Stents; D018084:Ultrasonography, Interventional
D000925:Anticoagulants; D006493:Heparin