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

Abstract

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.