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Limits: Publication Date from 2003/10/01 to
2005/02/01

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1: Am
Heart J. 2004 Oct;148(4):663-9.

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Randomized comparison of
debulking followed by stenting versus stenting alone for ostial left
anterior descending artery stenosis: intravascular ultrasound
guidance.

Kim YH, Hong MK, Lee SW, Lee CW, Han KH,
Kim JJ, Park SW, Mintz GS, Park SJ.

Department of Medicine,
Asan Medical Center, University of Ulsan College of Medicine, Seoul,
South Korea.

BACKGROUND: Although directional coronary
atherectomy (DCA) before stenting has the advantage of combining
substantial removal of atheromatous plaque and prevention of elastic
recoil, there has been no randomized study to investigate its efficacy
in ostial left anterior descending artery (LAD) lesions. This study was
aimed to evaluate the effect of DCA followed by stenting on ostial LAD
stenosis under the guidance of intravascular ultrasound (IVUS). METHODS:
Eighty-six patients with ostial LAD stenoses were randomly assigned to
DCA followed by stenting (group I) or stenting alone (group II).
Aggressive DCA or optimal stenting was performed in both groups under
the guidance of IVUS. The primary end point was angiographic restenosis
at 6 months. RESULTS: Baseline clinical and angiographic characteristics
were similar between the 2 groups. The postprocedural minimal lumen
diameter was larger in group I than group II (4.0 +/- 0.4 mm vs. 3.5 +/-
0.5 mm, P <.001). However, the angiographic restenosis rates were not
significantly different between the 2 groups (9/32 [28.1%] in group I
vs. 11/30 [36.7%] in group II, P =.472). The postprocedural IVUS stent
area was the only independent determinant of restenosis by multivariate
analysis (odds ratio.61, 95% CI 0.41-0.92, P =.018). CONCLUSIONS: DCA
followed by stenting achieved greater lumen gain than stenting alone for
ostial LAD stenosis. However, DCA did not improve angiographic
restenosis.

PMID: 15459598 [PubMed - in process]

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