Comparison of directional coronary atherectomy-based intervention and stenting alone in ostial lesions of the left anterior descending artery.

Background: Balloon angioplasty yields suboptimal results and increases the rate of restenosis in the ostium of the left anterior descending coronary artery (LAD). Several non-balloon devices have been used to improve the outcome of dilatation of such lesions.

Methods: This investigation retrospectively compared the results of a directional atherectomy (DCA)-based intervention and stenting alone on the ostial lesions of the LAD, and the effect on the left circumflex artery (LCX) ostium. Sixty-five patients with a successful angioplasty of LAD ostial lesions were studied. Patients were divided into 2 groups: group I (DCA, n = 34) and group II (stenting, n = 31).

Results: After intervention and at the 3-month follow-up, group I exhibited a larger minimal lumen diameter (MLD), smaller-diameter stenosis, and a lower loss index than group II. At 6 months, group I showed a lower cumulative restenosis rate of 32% as compared to 48% for group II (p = 0.04). In group I, the MLD of the LCX ostium had not changed after DCA or at follow-up. In contrast, the MLD of the LCX was significantly reduced with stenting alone and during follow-up (p < 0.01). The strategy of optimal debulking plus stenting exhibited a restenosis rate of 9%, in contrast to 33% in the optimal debulking alone strategy (p = 0.05) after 3 months.

Conclusions: During the intervention for LAD ostial lesions, the DCA-based strategy seemed to be superior compared to stenting alone both in terms of acute and late target lesion revascularization and in terms of the risk of plaque shifting. The best results however were obtained when optimal DCA was combined with stenting.