Long-Term Outcomes of Stent-Less Strategy Using Directional Coronary Atherectomy for the Ostial Left Circumflex Artery.

Background: Long-term outcomes of percutaneous coronary intervention (PCI) for left circumflex artery (LCX) ostial lesions remain suboptimal. While a stent-less strategy using directional coronary atherectomy (DCA) and drug-eluting balloon (DEB) may offer a potential solution, no studies have reported on its long-term outcomes.

Aims: This study aims to evaluate the long-term outcomes of a stent-less PCI strategy using DCA and DEB for LCX ostial lesions.

Methods: We retrospectively analyzed consecutive patients treated for LCX ostial lesions with DCA to reduce plaque area to < 60%, followed by DEB angioplasty, at Saiseikai Utsunomiya Hospital, Tochigi, Japan, between January 2019 and January 2024. The primary endpoint was clinically driven target lesion revascularization. Secondary endpoints included major adverse cardiac events, defined as a composite of cardiac death, myocardial infarction (MI), and ischemia-driven target vessel revascularization, as well as bleeding complications.

Results: Ten patients were included, five of whom had diabetes mellitus. A total of 80% had concomitant left main trunk (LMT) to left anterior descending artery (LAD) lesions; 60% underwent crossover stenting for LMT-LAD after LCX DCA, while two were treated with DCA and DEB for both LCX and LMT-LAD. All patients underwent follow-up using coronary computed tomography or angiography, with a follow-up period ranging from 8 to 56 months (median: 22 months, IQR: 21.7). TLR occurred in one patient (10%). No cases of cardiac death, MI, or bleeding complications were observed.

Conclusions: DCA followed by DEB demonstrated favorable long-term outcomes for LCX ostial lesions, providing a viable alternative to conventional stent-based PCI strategies.