Unprotected left main coronary artery bifurcation stenosis: impact of plaque debulking prior to single sirolimus-eluting stent implantation

J Invasive Cardiol. 2008 Oct;20(10):505-10.

Abstract

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).

Conclusion: Plaque debulking with DCA prior to single SES implantation effectively reduced restenosis of the LCx ostium in this challenging lesion subset.

Publication types

  • Multicenter Study

MeSH terms

  • Aged
  • Angioplasty, Balloon, Coronary / instrumentation
  • Angioplasty, Balloon, Coronary / methods*
  • Aspirin / therapeutic use
  • Clopidogrel
  • Coronary Artery Disease / pathology
  • Coronary Artery Disease / surgery*
  • Coronary Vessels / pathology
  • Coronary Vessels / surgery*
  • Drug-Eluting Stents / adverse effects*
  • Feasibility Studies
  • Humans
  • Myocardial Infarction / prevention & control
  • Platelet Aggregation Inhibitors / therapeutic use
  • Prospective Studies
  • Risk Factors
  • Sirolimus / administration & dosage
  • Sirolimus / therapeutic use*
  • Ticlopidine / analogs & derivatives
  • Ticlopidine / therapeutic use

Substances

  • Platelet Aggregation Inhibitors
  • Clopidogrel
  • Ticlopidine
  • Aspirin
  • Sirolimus