Effectiveness of sirolimus-eluting stent implantation for the treatment of ostial left anterior descending artery stenosis with intravascular ultrasound guidance.
OBJECTIVE
This study was designed to evaluate the clinical and angiographic outcomes of sirolimus-eluting stent (SES) implantation for ostial left anterior descending (LAD) lesions compared with bare-metal stent (BMS) implantation.


BACKGROUND
The effectiveness of SES implantation for ostial LAD lesions is currently unknown.


METHODS
Sirolimus-eluting stents were implanted in 68 consecutive patients with ostial LAD stenoses. The control group was composed of 77 patients treated with BMS during the preceding two years. In the SES group, for complete lesion coverage, stent positioning was intentionally extended into the distal left main coronary artery (LMCA) in 23 patients (34%) with intermediate LMCA narrowing.


RESULTS
Compared with the BMS group, the SES group had more multivessel involvement, received fewer debulking atherectomies, underwent more direct stenting, had a greater number of stents, and had more segments stented. The procedural success rate was 100% in both groups. The six-month angiographic restenosis rate was significantly lower in the SES group than in the BMS group (5.1% vs. 32.3%, p < 0.001). During the one-year follow-up period, neither death nor myocardial infarction occurred in either group, but target lesion revascularization was less frequent in the SES group than in the BMS group (0% vs. 17%, p < 0.001). In the SES group, there were no restenoses in cases with LMCA coverage, compared with three restenoses (7.9%) in cases with precise stent positioning (p = NS).


CONCLUSIONS
Sirolimus-eluting stent implantation in ostial LAD lesions achieved excellent results regarding restenosis and clinical outcomes compared with BMS implantation. This finding may be associated with reduced neointimal hyperplasia and complete lesion coverage.
Seung
Ki-Bae
KB
Catholic University Hospital, Seoul, Korea.
Kim
Young-Hak
YH
Park
Duk-Woo
DW
Lee
Bong-Ki
BK
Lee
Cheol Whan
CW
Hong
Myeong-Ki
MK
Kim
Pum-Joon
PJ
Chung
Wook-Sung
WS
Tahk
Seung-Jea
SJ
Park
Seong-Wook
SW
Park
Seung-Jung
SJ
D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000517:prevention & control; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000601:surgery*; D003692:Delayed-Action Preparations; D016503:Drug Delivery Systems; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D020123:Sirolimus / Q000008:administration & dosage / Q000627:therapeutic use*; D015607:Stents; D014463:Ultrasonography
D003692:Delayed-Action Preparations; D007166:Immunosuppressive Agents; D020123:Sirolimus