Unprotected left main coronary artery bifurcation stenosis: impact of plaque debulking prior to single sirolimus-eluting stent implantation.
BACKGROUND
The impact of plaque debulking with directional coronary atherectomy (DCA) prior to single sirolimus-eluting stent (SES) implantation in an unprotected left main coronary artery (LMCA) involving bifurcation stenosis has not been fully evaluated.


METHODS
One hundred and one patients with unprotected LMCA bifurcation lesions treated with single SES implantation (from the LMCA to the left descending coronary artery [LAD] across the left circumflex artery [LCx] ostium) were divided into 2 groups: DCA group (n = 41, plaque debulking with DCA prior to SES implantation) and non-DCA group (n = 60, single SES implantation alone). Clinical outcomes as well as angiographic data at baseline, post procedure and follow up were compared between the two groups.


RESULTS
At 1-year follow up, freedom from major adverse cardiac events was 97.4 +/- 2.6% in the DCA group, and 88.6 +/- 4.4% in the non-DCA group (p = 0.129). Baseline quantitative coronary angiographic analyses revealed that the percent diameter stenosis (%DS) of the LCx was higher in the DCA group than in the non-DCA group (36.8 +/- 21.5% vs. 26.9 +/- 19.2%; p = 0.029). Moreover, the %DS of the LCx after PCI and at 9-month follow up was lower in the DCA group (19.2 +/- 13.1% vs. 28.3 +/- 22.7%; p = 0.034; 20.8 +/- 12.3% vs. 31.9 +/- 21.4%; p = 0.007, respectively). Furthermore, restenosis at the LCx ostium was not observed in the DCA group, but was seen in 5 cases in the non-DCA group (0% vs. 10.2%; p = 0.048).


CONCLUSIONS
Plaque debulking with DCA prior to single SES implantation effectively reduced restenosis of the LCx ostium in this challenging lesion subset.
Tanaka
Nobuyoshi
N
Department of Cardiology, Toyohashi Heart Center, 21-1 Gobudori, Oyama-cho, Toyohashi, 441-8530, Japan. ntanaka@heart-center.or.jp
Terashima
Mitsuyasu
M
Kinoshita
Yoshihisa
Y
Kimura
Masashi
M
Nasu
Kenya
K
Ehara
Mariko
M
Tsuchikane
Etsuo
E
Matsubara
Tetsuo
T
Asakura
Yasushi
Y
Katoh
Osamu
O
Suzuki
Takahiko
T
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000295:instrumentation / Q000379:methods*; D001241:Aspirin / Q000627:therapeutic use; D000077144:Clopidogrel; D003324:Coronary Artery Disease / Q000473:pathology / Q000601:surgery*; D003331:Coronary Vessels / Q000473:pathology / Q000601:surgery*; D054855:Drug-Eluting Stents / Q000009:adverse effects*; D005240:Feasibility Studies; D006801:Humans; D009203:Myocardial Infarction / Q000517:prevention & control; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011446:Prospective Studies; D012307:Risk Factors; D020123:Sirolimus / Q000008:administration & dosage / Q000627:therapeutic use*; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000627:therapeutic use
D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin; D020123:Sirolimus