Abstract
Background
Drug‐eluting stents (DES) are superior to bare metal stents (BMS) for treating ostial left anterior descending artery (LAD) lesions, but DES is not suitable for all patients in real life practice.
Hypothesis
We hypothesize that cutting balloon angioplasty (CBA) followed by BMS (CBA + BMS) for treating ostial LAD lesions is an alternative strategy.
Methods
In our study, 101 consecutive patients (51 with DES and 50 with CBA + BMS) with ostial LAD stenting were included for retrospective investigation between November 2003 and May 2005. The target vessel diameter was ≥3.0 mm.
Results
We compared the DES group with the CBA + BMS group, the rates of restenosis (10.3% versus 17.9%, p = 0.386), target lesion revascularization (TLR) (5.88% versus 10%, p = 0.487) and major adverse cardiac events (MACE) (7.84% versus 12%, p = 0.525) were similar at 6–8 months angiographic follow‐up, but there were higher bleeding events in the DES group (p = 0.033). During a 2‐year clinical follow‐up, no myocardial infarction occurred in the 2 groups, the rates of TLR (7.84% versus 10%, p = 0.741) and MACE (9.8% versus 12%, p = 0.723) were also similar. The MACE‐free survival rate was 90.2% versus 88 % (p = 0.723).
Conclusions
The CBA + BMS combination has a good long‐term clinical effect in the treatment of ostial LAD lesions; it might be an alternative strategy for patients with contraindication for DES implantation, or patients who cannot endure long‐term dual antiplatelet medication, or in elderly patients. Copyright © 2009 Wiley Periodicals, Inc.
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References
- 1. Brown R, Kochar B, Maniet ER, et al. Effects of coronary angioplasty using progressive dilation on ostial stenosis of the left anterior descending artery. Am J Cardiol 1993; 71: 245–247. [DOI] [PubMed] [Google Scholar]
- 2. Park SJ, Lee CW, Hong MK, Kim JJ, Park SW. Stent placement for ostial left anterior descending coronary artery stenosis acute and long‐term (2‐year) results. Catheter Cardiovasc Interv 2000; 49: 267–271. [DOI] [PubMed] [Google Scholar]
- 3. Tsagalou E, Stankovic G, Iakovou I, et al. Early outcome of treatment of ostial de novo left anterior descending coronary artery lesions with drug‐eluting stents. Am J Cardiol 2006; 97(2): 187–191. [DOI] [PubMed] [Google Scholar]
- 4. Moses JW, Leon MB, Popma JJ, et al. Sirolimus‐eluting stents versus standard stents in patients with stenosis in a native coronary artery. N Engl J Med 2003; 349(14): 1315–1323. [DOI] [PubMed] [Google Scholar]
- 5. Stone GW, Ellis SG, Cox DA, et al; TAXUS‐IV Investigators . A polymer‐based, paclitaxel‐eluting stent in patients with coronary artery disease. N Engl J Med 2004; 350(3): 221–231. [DOI] [PubMed] [Google Scholar]
- 6. Pfisterer M, Brunner‐La Rocca HP, Buser PT, et al. Late clinical events after clopidogrel discontinuation may limit the benefit of drug‐eluting stents: an observational study of drug‐eluting versus bare‐metal stents. J Am Coll Cardiol 2006; 48(12): 2584–2591. [DOI] [PubMed] [Google Scholar]
- 7. Mauri L, Hsieh WH, Massaro JM, et al. Stent thrombosis in randomized clinical trials of drug‐eluting stents. N Engl J Med 2007; 356(10): 1020–1029. [DOI] [PubMed] [Google Scholar]
- 8. Chen JL, Gao RL, Yang YJ, et al. Evaluation on the safety and efficacy of cutting balloon (Chinese). Chin J Cardiol 2002; (30): 263–264. [Google Scholar]
- 9. Ajani AE, Kim HS, Castagna M, et al. Clinical utility of the cutting balloon. J Invasive Cardiol 2001; 13: 554–557. [PubMed] [Google Scholar]
- 10. Simonton CA, Leon MB, Baim DS, et al. 'Optimal' directional coronary atherectomy: final results of the Optimal Atherectomy Restenosis Study (OARS). Circulation 1998; 97(4): 332–339. [DOI] [PubMed] [Google Scholar]
- 11. Zampieri P, Colombo A, Almagor Y, Maiello L, Finci L. Results of coronary stenting of ostial lesions. Am J Cardiol 1994; 73(12): 901–903. [DOI] [PubMed] [Google Scholar]
- 12. Muramatsu T, Tsukahara R, Ho M, et al. Efficacy of cutting balloon angioplasty for lesions at the ostium of the coronary arteries. J Invasive Cardiol 1999; 11(4): 201–206. [PubMed] [Google Scholar]
- 13. Inoue T, Sakai Y, Hoshi K, et al. Lower expression of neutrophil adhesion molecule indicates less vessel wall injury and might explain lower restenosis rate after cutting balloon angioplasty. Circulation 1998; 97: 2511–2518. [DOI] [PubMed] [Google Scholar]