title: [Effects of treating ostial left anterior descending artery stenosis by drug eluting stents via precisely positioning or crossing over into left main stem].
abstract: OBJECTIVE
  To compare the effect of treating ostial left anterior descending artery (LAD) stenosis using drug-eluting stents (DES) by precisely positioning versus crossing over into left main (LM) technique.
  
  
  METHODS
  From April 2004 to May 2006, DES implantations in 224 consecutive patients with ostial LAD lesions were performed by precisely positioning in 161 patients (P group) and crossing over into LM in 63 patients (C group). Clinical and angiographic follow-up was performed at 7 months post DES implantations.
  
  
  RESULTS
  Relevant vessel diameter (RVD) was significantly larger (3.44 +/- 0.52 mm vs. 3.17 +/- 0.40 mm, P = 0.039) and LM/LAD diameter ratio was significantly lower (1.16 +/- 0.07 vs. 1.28 +/- 0.05, P = 0.000) in C group compared that in P group. Stent (3.53 +/- 0.31 mm vs. 3.16 +/- 0.29 mm, P = 0.035) and postdilatation balloon (3.59 +/- 0.65 mm vs. 3.24 +/- 0.32 mm, P = 0.035) diameter were significantly larger and postdilatation (94.1% vs. 29.5%, P = 0.000) and kissing balloon (47.1% vs. 15.2%, P = 0.000) rates were significantly higher in P group than that in C group. Both groups achieved 100% procedure success rate. Major adverse cardiac events (MACE) rate (4.3% vs. 1.6%, P = 0.447), death (0 vs. 0, P = 1.000), AMI (1, 2% vs. 1.6%, P = 1.000) and target vessel revascularization (TVR) rate (3.1% vs. 0%, P = 0.325) were similar between the 2 groups. One patient in P group developed subacute in-stent thrombosis. Follow-up angiography at 7 months showed that in-stent (0 vs.7.7%, P = 0.316) and in-segment restenosis rate (3.8%vs. 10.8%, P = 0.431) tended to be lower while in-stent (0.12 +/- 0.08 mm vs. 0.59 +/- 0.37 mm, P = 0.000) and in-segment (0.17 +/- 0.09 mm vs. 0.64 +/- 0.49 mm, P = 0.000) late loss were significantly lower in C group compared with P group.
  
  
  CONCLUSIONS
  Compared with precisely positioning technique, crossing over into LM technique was more feasible and tended to reduce restenosis rate for ostial LAD lesions treated with DES.
authors.affiliation: Chinese Academy of Medical Science, Beijing 100037, China. gaowangjia@163.com
authors.forename: Zhan
authors.initials: Z
authors.lastname: Gao
authors.forename: Yue-jin
authors.initials: YJ
authors.lastname: Yang
authors.forename: Ji-lin
authors.initials: JL
authors.lastname: Chen
authors.forename: Shu-bin
authors.initials: SB
authors.lastname: Qiao
authors.forename: Bo
authors.initials: B
authors.lastname: Xu
authors.forename: Xue-wen
authors.initials: XW
authors.lastname: Qin
authors.forename: Min
authors.initials: M
authors.lastname: Yao
authors.forename: Hai-bo
authors.initials: HB
authors.lastname: Liu
authors.forename: Yong-jian
authors.initials: YJ
authors.lastname: Wu
authors.forename: Jin-qing
authors.initials: JQ
authors.lastname: Yuan
authors.forename: Jue
authors.initials: J
authors.lastname: Chen
authors.forename: Shi-jie
authors.initials: SJ
authors.lastname: You
authors.forename: Jian-jun
authors.initials: JJ
authors.lastname: Li
authors.forename: Run-lin
authors.initials: RL
authors.lastname: Gao
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D003324:Coronary Artery Disease / Q000628:therapy*; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies