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Lam MK, Sen H, Tandjung K, Löwik MM, Basalus MW, Mewes JC, Stoel MG, van Houwelingen KG, Linssen GC, Ijzerman MJ, Doggen CJ, von Birgelen C. Clinical outcome of patients with implantation of second-generation drug-eluting stents in the right coronary ostium: Insights from 2-year follow-up of the TWENTE trial. Catheter Cardiovasc Interv 2014; 85:524-31. [DOI: 10.1002/ccd.25518] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 04/14/2014] [Indexed: 11/08/2022]
Affiliation(s)
- Ming Kai Lam
- Department of Cardiology; Thoraxcentrum Twente, Medisch Spectrum Twente; Enschede Netherlands
| | - Hanim Sen
- Department of Cardiology; Thoraxcentrum Twente, Medisch Spectrum Twente; Enschede Netherlands
| | - Kenneth Tandjung
- Department of Cardiology; Thoraxcentrum Twente, Medisch Spectrum Twente; Enschede Netherlands
| | - Marije M. Löwik
- Department of Cardiology; Thoraxcentrum Twente, Medisch Spectrum Twente; Enschede Netherlands
| | - Mounir W.Z. Basalus
- Department of Cardiology; Thoraxcentrum Twente, Medisch Spectrum Twente; Enschede Netherlands
| | - Janne C. Mewes
- Health Technology and Services Research; MIRA-Institute for Biomedical Technology and Technical Medicine, University of Twente; Enschede Netherlands
| | - Martin G. Stoel
- Department of Cardiology; Thoraxcentrum Twente, Medisch Spectrum Twente; Enschede Netherlands
| | - K. Gert van Houwelingen
- Department of Cardiology; Thoraxcentrum Twente, Medisch Spectrum Twente; Enschede Netherlands
| | | | - Maarten J. Ijzerman
- Health Technology and Services Research; MIRA-Institute for Biomedical Technology and Technical Medicine, University of Twente; Enschede Netherlands
| | - Carine J.M. Doggen
- Health Technology and Services Research; MIRA-Institute for Biomedical Technology and Technical Medicine, University of Twente; Enschede Netherlands
| | - Clemens von Birgelen
- Department of Cardiology; Thoraxcentrum Twente, Medisch Spectrum Twente; Enschede Netherlands
- Health Technology and Services Research; MIRA-Institute for Biomedical Technology and Technical Medicine, University of Twente; Enschede Netherlands
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2
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Golmohamadi Z, Sokhanvar S, Aslanabadi N, Ghaffari S, Sohrabi B. One-Year Outcomes After Everolimus-Eluting Stents Implantation in Ostial Lesions of Left Anterior Descending Coronary Arteries. Cardiol Res 2013; 4:192-198. [PMID: 28352444 PMCID: PMC5358308 DOI: 10.4021/cr295w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2013] [Indexed: 11/30/2022] Open
Abstract
Background In recent years, stents are increasingly used in variety of coronary lesions. Ostial lesion of left anterior descending coronary artery (LAD) however remains a challenge area because of the invariable involvement of distal left main coronary artery (LMCA). This study was designed to evaluate the clinical and angiographic outcomes of everolimus-eluting stent (EES) implantation for ostial LAD. Methods EESs were implanted in 45 consecutive patients with ostial LAD stenoses. For complete lesion coverage, stent positing was extended into the distal LMCA in 6 patients (13.3%) with intermediated LMCA narrowing. We assess MACE during one-year follow-up. Results In-hospital success rate was 100%; neither cardiac death nor stent thrombosis in our patients, but two patients had myocardial infarction in non-related coronary artery during follow-up. Two patients had angiographic restenosis and underwent TLR. The cumulative MACE-free survival rate was 95.6% at one year. Conclusion EES was in ostial LAD lesions with complete lesion coverage achieving high procedural success rate and acceptable clinical outcomes during one-year follow-up period.
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Affiliation(s)
- Zahra Golmohamadi
- Cardiovascular Research Center, Shaheed Madani Heart Hospital, Medical Science University, Tabriz, Iran
| | - Sepideh Sokhanvar
- Ayatollah Mosavi Cardiology Department, Medical Science University, Zanjan, Iran
| | - Naser Aslanabadi
- Cardiovascular Research Center, Shaheed Madani Heart Hospital, Medical Science University, Tabriz, Iran
| | - Samad Ghaffari
- Cardiovascular Research Center, Shaheed Madani Heart Hospital, Medical Science University, Tabriz, Iran
| | - Bahram Sohrabi
- Cardiovascular Research Center, Shaheed Madani Heart Hospital, Medical Science University, Tabriz, Iran
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3
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Hsieh IC, Chen CC, Chang SH, Hsieh MJ, Wang CY, Lee CH, Lin FC. Acute and long-term outcomes of drug-eluting stent implantations in aorto-ostial, left anterior descending artery-ostial, and nonostial lesions. Catheter Cardiovasc Interv 2013; 82:727-34. [DOI: 10.1002/ccd.24943] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Revised: 02/13/2013] [Accepted: 04/07/2013] [Indexed: 11/06/2022]
Affiliation(s)
- I-Chang Hsieh
- Second Section of Cardiology; Department of Medicine and PCI Center; Chang Gung Memorial Hospital; Tao-Yuan Taiwan
| | - Chun-Chi Chen
- Second Section of Cardiology; Department of Medicine and PCI Center; Chang Gung Memorial Hospital; Tao-Yuan Taiwan
| | - Shang-Hung Chang
- Second Section of Cardiology; Department of Medicine and PCI Center; Chang Gung Memorial Hospital; Tao-Yuan Taiwan
| | - Ming-Jer Hsieh
- Second Section of Cardiology; Department of Medicine and PCI Center; Chang Gung Memorial Hospital; Tao-Yuan Taiwan
| | - Chao-Yung Wang
- Second Section of Cardiology; Department of Medicine and PCI Center; Chang Gung Memorial Hospital; Tao-Yuan Taiwan
| | - Cheng-Hung Lee
- Second Section of Cardiology; Department of Medicine and PCI Center; Chang Gung Memorial Hospital; Tao-Yuan Taiwan
| | - Fen-Chiung Lin
- Second Section of Cardiology; Department of Medicine and PCI Center; Chang Gung Memorial Hospital; Tao-Yuan Taiwan
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4
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Kishi K, Kimura T, Morimoto T, Namura M, Muramatsu T, Nishikawa H, Hiasa Y, Isshiki T, Nobuyoshi M, Mitsudo K. Sirolimus-Eluting Stent Implantation for Ostial Left Anterior Descending Coronary Artery Lesions. Circ Cardiovasc Interv 2011; 4:362-70. [DOI: 10.1161/circinterventions.111.961904] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Ostial left anterior descending coronary artery (LAD) lesion has been regarded as a lesion subset unsuitable for coronary stenting. Long-term outcomes of sirolimus-eluting stent (SES) implantation for ostial LAD lesions have not been adequately evaluated.
Methods and Results—
Among 12 824 patients enrolled in the j-Cypher Registry, 3-year outcomes were compared between 481 patients with SES-treated ostial LAD lesions and 5369 patients with SES-treated nonostial proximal LAD lesions. Patients with ostial LAD lesions had similar incidences of target lesion revascularization (TLR) as those with nonostial proximal LAD lesions (9.4% versus 9.7%;
P
=0.98; adjusted hazard ratio [HR], 0.99; 95% CI, 0.7 to 1.36;
P
=0.94) and death/myocardial infarction (MI) (10.7% versus 11.4%;
P
=0.82; adjusted HR, 1.05; 95% CI, 0.76 to 1.4;
P
=0.77). Among the patients with ostial LAD lesions, those undergoing both main and side branch stenting (n=62) compared to main branch stenting alone (n=419) had a higher risk for TLR (adjusted HR, 4.65; 95% CI, 2.32 to 9.25;
P
<0.0001) but similar risk for death/MI (adjusted HR, 1.15; 95% CI, 0.49 to 2.41;
P
=0.73). In patients with main branch stenting alone, outcomes after crossover stenting across the circumflex coronary artery (n=225) were not different from those after ostial stenting (n=194) for TLR (adjusted HR, 0.77; 95% CI, 0.33 to 1.82;
P
=0.55) and for death/MI (adjusted HR, 1.54; 95% CI, 0.78 to 3.2;
P
=0.22).
Conclusions—
In terms of both safety and efficacy, 3-year outcomes of percutaneous coronary intervention using SES for ostial LAD lesions were comparable to those for nonostial proximal LAD lesions. Crossover stenting with a 1-stent approach might be a reasonable option in treating ostial LAD lesions.
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Affiliation(s)
- Koichi Kishi
- From the Division of Cardiology, Tokushima Red Cross Hospital, Tokushima, Japan (K.K., Y.H.); Department of Cardiovascular Medicine (T.K.) and Center for Medical Education and Clinical Epidemiology Unit (T. Morimoto), Graduate School of Medicine, Kyoto University, Kyoto, Japan; Division of Cardiology, Kanazawa Cardiovascular Hospital, Kanazawa, Japan (M. Namura); Division of Cardiology, Kawasaki Social Insurance Hospital, Kanagawa, Japan (T. Muramatsu); Division of Cardiology, Mie Heart Center, Mie,
| | - Takeshi Kimura
- From the Division of Cardiology, Tokushima Red Cross Hospital, Tokushima, Japan (K.K., Y.H.); Department of Cardiovascular Medicine (T.K.) and Center for Medical Education and Clinical Epidemiology Unit (T. Morimoto), Graduate School of Medicine, Kyoto University, Kyoto, Japan; Division of Cardiology, Kanazawa Cardiovascular Hospital, Kanazawa, Japan (M. Namura); Division of Cardiology, Kawasaki Social Insurance Hospital, Kanagawa, Japan (T. Muramatsu); Division of Cardiology, Mie Heart Center, Mie,
| | - Takeshi Morimoto
- From the Division of Cardiology, Tokushima Red Cross Hospital, Tokushima, Japan (K.K., Y.H.); Department of Cardiovascular Medicine (T.K.) and Center for Medical Education and Clinical Epidemiology Unit (T. Morimoto), Graduate School of Medicine, Kyoto University, Kyoto, Japan; Division of Cardiology, Kanazawa Cardiovascular Hospital, Kanazawa, Japan (M. Namura); Division of Cardiology, Kawasaki Social Insurance Hospital, Kanagawa, Japan (T. Muramatsu); Division of Cardiology, Mie Heart Center, Mie,
| | - Masanobu Namura
- From the Division of Cardiology, Tokushima Red Cross Hospital, Tokushima, Japan (K.K., Y.H.); Department of Cardiovascular Medicine (T.K.) and Center for Medical Education and Clinical Epidemiology Unit (T. Morimoto), Graduate School of Medicine, Kyoto University, Kyoto, Japan; Division of Cardiology, Kanazawa Cardiovascular Hospital, Kanazawa, Japan (M. Namura); Division of Cardiology, Kawasaki Social Insurance Hospital, Kanagawa, Japan (T. Muramatsu); Division of Cardiology, Mie Heart Center, Mie,
| | - Toshiya Muramatsu
- From the Division of Cardiology, Tokushima Red Cross Hospital, Tokushima, Japan (K.K., Y.H.); Department of Cardiovascular Medicine (T.K.) and Center for Medical Education and Clinical Epidemiology Unit (T. Morimoto), Graduate School of Medicine, Kyoto University, Kyoto, Japan; Division of Cardiology, Kanazawa Cardiovascular Hospital, Kanazawa, Japan (M. Namura); Division of Cardiology, Kawasaki Social Insurance Hospital, Kanagawa, Japan (T. Muramatsu); Division of Cardiology, Mie Heart Center, Mie,
| | - Hideo Nishikawa
- From the Division of Cardiology, Tokushima Red Cross Hospital, Tokushima, Japan (K.K., Y.H.); Department of Cardiovascular Medicine (T.K.) and Center for Medical Education and Clinical Epidemiology Unit (T. Morimoto), Graduate School of Medicine, Kyoto University, Kyoto, Japan; Division of Cardiology, Kanazawa Cardiovascular Hospital, Kanazawa, Japan (M. Namura); Division of Cardiology, Kawasaki Social Insurance Hospital, Kanagawa, Japan (T. Muramatsu); Division of Cardiology, Mie Heart Center, Mie,
| | - Yoshikazu Hiasa
- From the Division of Cardiology, Tokushima Red Cross Hospital, Tokushima, Japan (K.K., Y.H.); Department of Cardiovascular Medicine (T.K.) and Center for Medical Education and Clinical Epidemiology Unit (T. Morimoto), Graduate School of Medicine, Kyoto University, Kyoto, Japan; Division of Cardiology, Kanazawa Cardiovascular Hospital, Kanazawa, Japan (M. Namura); Division of Cardiology, Kawasaki Social Insurance Hospital, Kanagawa, Japan (T. Muramatsu); Division of Cardiology, Mie Heart Center, Mie,
| | - Takaaki Isshiki
- From the Division of Cardiology, Tokushima Red Cross Hospital, Tokushima, Japan (K.K., Y.H.); Department of Cardiovascular Medicine (T.K.) and Center for Medical Education and Clinical Epidemiology Unit (T. Morimoto), Graduate School of Medicine, Kyoto University, Kyoto, Japan; Division of Cardiology, Kanazawa Cardiovascular Hospital, Kanazawa, Japan (M. Namura); Division of Cardiology, Kawasaki Social Insurance Hospital, Kanagawa, Japan (T. Muramatsu); Division of Cardiology, Mie Heart Center, Mie,
| | - Masakiyo Nobuyoshi
- From the Division of Cardiology, Tokushima Red Cross Hospital, Tokushima, Japan (K.K., Y.H.); Department of Cardiovascular Medicine (T.K.) and Center for Medical Education and Clinical Epidemiology Unit (T. Morimoto), Graduate School of Medicine, Kyoto University, Kyoto, Japan; Division of Cardiology, Kanazawa Cardiovascular Hospital, Kanazawa, Japan (M. Namura); Division of Cardiology, Kawasaki Social Insurance Hospital, Kanagawa, Japan (T. Muramatsu); Division of Cardiology, Mie Heart Center, Mie,
| | - Kazuaki Mitsudo
- From the Division of Cardiology, Tokushima Red Cross Hospital, Tokushima, Japan (K.K., Y.H.); Department of Cardiovascular Medicine (T.K.) and Center for Medical Education and Clinical Epidemiology Unit (T. Morimoto), Graduate School of Medicine, Kyoto University, Kyoto, Japan; Division of Cardiology, Kanazawa Cardiovascular Hospital, Kanazawa, Japan (M. Namura); Division of Cardiology, Kawasaki Social Insurance Hospital, Kanagawa, Japan (T. Muramatsu); Division of Cardiology, Mie Heart Center, Mie,
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5
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Capranzano P, Sanfilippo A, Tagliareni F, Capodanno D, Monaco S, Sardella G, Giordano A, Sangiorgi GM, Tamburino C. Long-term outcomes after drug-eluting stent for the treatment of ostial left anterior descending coronary artery lesions. Am Heart J 2010; 160:973-8. [PMID: 21095288 DOI: 10.1016/j.ahj.2010.07.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2010] [Accepted: 07/02/2010] [Indexed: 11/24/2022]
Abstract
BACKGROUND Although drug-eluting stents (DES) have reduced restenosis in a broad range of lesions, there is limited data, from relatively small studies, on the safety and efficacy of DES for isolated ostial left anterior descending (LAD) stenoses. In addition, in the setting of these high-risk lesions, there is the issue of the potential involvement of the left main (LM) bifurcation, requiring subsequent revascularization for a lesion involving this critical location. METHODS Patients with a de novo isolated unprotected ostial LAD stenoses treated with DES were included. Evaluated end points were cardiac death, nonfatal myocardial infarction, overall target lesion revascularization (TLR), and the reintervention for a restenotic lesion located at the LM segment adjacent to the stent (TLR-LM). RESULTS A total of 162 patients were included: 95 underwent focal ostial LAD stenting and 67 stenting from the distal LM into the LAD ostium. The 2-year Kaplan-Meier estimates of cardiac death, nonfatal myocardial infarction, overall TLR, and TLR-LM were 2.6%, 2.1%, 8.3%, and 4.7%, respectively. Overall TLR and TLR-LM rates were higher in the focal ostial LAD stenting group. There was a trend toward an independent increased risk of TLR associated with focal ostial stenting. In addition, final minimal luminal diameter trended to be independently associated with TLR. CONCLUSION The present study showed that DES for isolated ostial LAD lesions is a feasible, safe, and effective treatment strategy. In addition, this study suggested the hypothesis that a default distal LM-LAD stenting, rather than focal ostial stenting, might provide more favorable outcomes. Nevertheless, larger specifically designed studies are needed.
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6
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Vulnerable carina anatomy and ostial lesions in the left anterior descending coronary artery after floating-stent treatment. Rev Esp Cardiol 2010; 62:1240-9. [PMID: 19889335 DOI: 10.1016/s1885-5857(09)73351-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION AND OBJECTIVES Percutaneous coronary intervention for ostial lesions of the left anterior descending coronary artery (LAD) remains a complex procedure. The aim of this study was to evaluate the usefulness of a method of treatment that we have termed the floating-stent approach. METHODS The study involved 71 patients with ostial LAD lesions who underwent implantation of a drug-eluting stent in the LAD, which totally or partially covered the ostium of the circumflex artery. No further interventions were planned. Intravascular ultrasound was performed both at baseline and after treatment in 49 patients. All were followed up clinically (16+/-12 months). RESULTS Angiography of the LAD demonstrated an immediate success rate of 100%. However, significant focal damage was observed in the circumflex ostium in 7 (10%) patients, three of whom needed treatment. The mean protrusion of the stent over the origin of the circumflex artery was 2.48+/-0.91 mm. The only predictor of circumflex ostial injury identified in the study was the carina having a spiky appearance on intravascular ultrasound, visible in the longitudinal view. We termed this feature the "eyebrow sign". Carina displacement was responsible for the focal damage in 13 of the 14 patient with this feature. Overall, the major cardiac adverse event rate during follow-up was 4%. CONCLUSIONS Use of the floating-stent technique for treating LAD ostial lesions was straightforward and gave excellent medium-term RESULTS Intravascular ultrasound showed that patients who had a carina with specific vulnerable anatomical features were predisposed to circumflex artery ostial injury.
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Medina A, Martín P, de Lezo JS, Amador C, de Lezo JS, Pan M, Melián F, Hernández E, Burgos L, Ojeda S, Ortega JR, García A. Anatomía vulnerable de la carina en lesiones ostiales de la arteria coronaria descendente anterior tratadas con stent flotante. Rev Esp Cardiol 2009. [DOI: 10.1016/s0300-8932(09)73076-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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8
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Gao LJ, Chen JL, Chen J, Yang YJ, Gao RL, Li JJ, Qin XW, Qiao SB, Xu B, Yao M, Liu HB, Wu YJ, Yuan JQ, Chen J, You SJ, Dai J. Long-term clinical efficacy of cutting balloon angioplasty followed by bare metal stent implantation for treating ostial left anterior descending artery lesions. Clin Cardiol 2009; 32:E31-5. [PMID: 19479973 DOI: 10.1002/clc.20400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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 > or =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.
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Affiliation(s)
- Li-Jian Gao
- Department of Cardiology, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
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9
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Outcomes after percutaneous coronary intervention of ostial lesions in the era of drug-eluting stents. Catheter Cardiovasc Interv 2009; 73:763-8. [DOI: 10.1002/ccd.21941] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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10
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Drug-eluting stents for the treatment of ostial coronary lesions: comparison of sirolimus-eluting stent with paclitaxel-eluting stent. Coron Artery Dis 2009; 19:507-11. [PMID: 18923247 DOI: 10.1097/mca.0b013e32830936d4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Treatment of ostial coronary lesions represents a challenge for interventional cardiologists. The efficacy of drug-eluting stents (DES) has been demonstrated as improving the outcomes of patients in a few studies. It is not known, however, which DES, sirolimus-eluting stent (SES) versus paclitaxel-eluting stent (PES), is superior for the treatment of ostial lesions. METHODS In this retrospective study, 95 consecutive patients with de-novo ostial lesions underwent coronary SES (n=47, lesions=48) or PES implantation (n=45, lesions=47), and quantitative coronary analysis was performed at the time of stent implantation and subsequently at 8 months post stenting. Ostial lesion was defined as > or =50% diameter stenosis rising within 3 mm of either left anterior descending coronary artery or left circumflex artery or right coronary artery measured by quantitative coronary analysis. Major adverse cardiac events including death, thrombosis, nonfatal myocardial infarction, and target lesion revascularization were compared between the two groups. RESULTS Baseline clinical and angiographic characteristics were well balanced between the two groups. At 8 months clinical and angiographic follow-up, overall major adverse cardiac events and target lesion revascularization rates were similar in both groups (6.4 vs. 11.2%, P=0.184; 4.3 vs. 8.9%, P=0.170, respectively). The in-stent and in-segment restenosis were, however, significantly higher in PES group compared with SES group (15.5 vs. 0%, P=0.001; 22.2 vs. 4.3%, P=0.003). Similarly, the late loss in both in-stent and in-segment was significantly higher in the PES group than in SES group (0.65+ or -0.67 vs. 0.16+ or -0.18 mm; 0.68+ or -0.65 vs. 0.15+ or -0.12 mm; P<0.001, respectively). CONCLUSION In this small sample-size, nonrandomized, and nonprospective study, the data indicated that implantation of DES appears safe and effective for the treatment of patients with de-novo ostial coronary lesions, but SES implantation showed more favorable results in respect of restenosis compared with PES implantation.
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11
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Three-dimensional coronary imaging for the ostium of the left anterior descending artery. Int J Cardiovasc Imaging 2008; 25:223-8. [PMID: 19034686 DOI: 10.1007/s10554-008-9385-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2008] [Accepted: 10/30/2008] [Indexed: 10/21/2022]
Abstract
Conventional coronary angiography is subject to a significant foreshortening of the proximal left anterior descending artery and overlapping of the left anterior descending artery and the circumflex artery that limits the accurate identification of the ostium of the left anterior descending artery. The aim of this study was to determine whether the three-dimensional (3D) reconstruction of traditional coronary angiography could optimize the projection angle to clearly show the ostium of the left anterior descending artery. The left main bifurcations of 18 consecutive patients were analyzed. A 3D image of the bifurcation was reconstructed from two conventional images and the optimal projection angle was chosen to clearly identify the ostium of the left anterior descending artery. The optimal angle was the right anterior oblique 18.8 +/- 20.9 degrees-caudal 26.9 +/- 32.3 degrees. The length from the left main trunk to the proximal left anterior descending artery on the optimal views was significantly longer than that on the routine views (25.0 +/- 6.1 vs. 22.4 +/- 5.3 mm, P = 0.011). The angles of the left main bifurcations were not substantially different between the optimal and the routine views. The optimal views selected using the 3D system provided clearer images of the ostium of the left anterior descending artery with less overlapping and foreshortening.
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12
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Lee CW, Tan CH, Suh J, Lee SW, Park DW, Lee SW, Kim YH, Hong MK, Kim JJ, Park SW, Park SJ. Sirolimus-eluting stent implantation for treatment of proximal left anterior descending coronary artery lesions: long-term outcome and predictors of adverse cardiac events. Catheter Cardiovasc Interv 2007; 70:368-73. [PMID: 17722041 DOI: 10.1002/ccd.21127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Acute and long-term results after sirolimus-eluting stent (SES) implantation of proximal left anterior descending coronary artery (LAD) disease were evaluated. BACKGROUND Although SES has been used increasingly for the treatment of LAD disease, data regarding their safety and efficacy in a real-world population are limited. METHODS We investigate the short- and long-term results in 966 patients who underwent SES implantation for stenosis of proximal LAD. RESULTS The procedural success rate was 97.6%, and procedural non-Q-wave myocardial infarction (MI) rate was 14.5%. In-hospital major complications occurred in five patients (0.5%), including three deaths and two Q-wave MIs. During follow-up (20.4 +/- 8.9 months), there were 16 deaths (1.7%; 10 cardiac, 6 noncardiac), 2 Q-wave MIs, and 22 target lesion revascularizations (2.3%). Late stent thrombosis occurred in two patients (0.2%), 14 and 23 months after the procedure. The event-free survival rates for cardiac death/Q-wave MI were 98.6% +/- 0.4% at 1 year and 97.8% +/- 0.6% at 2 years. The cumulative probabilities of survival without major adverse cardiac events (MACE) were 96.7% +/- 0.6% at 1 year and 95.4% +/- 0.8% at 2 years. In multivariate analysis, stented length (HR 1.04, 95%CI 1.01-1.07, P = 0.009) and infarct-related artery (HR 5.18, 95%CI 1.09-24.64, P = 0.039) were independently related to cardiac death/Q-wave MI. In addition, stented length (HR 1.04, 95%CI 1.02-1.06, P < 0.001) and left ventricular dysfunction (HR 2.66, 95%CI 1.07-6.63, P = 0.036) were significant independent predictors of MACE. CONCLUSIONS SES implantation for proximal LAD disease appears safe and effective in a real-world population, and the independent predictors of MACE included stented length and left ventricular dysfunction.
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Affiliation(s)
- Cheol Whan Lee
- Department of Medicine, Asan Medical Center, University of Ulsan, Seoul, Korea
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13
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Tsagalou E, Stankovic G, Stancovic G, Iakovou I, Melzi G, Cosgrave J, Ge L, Michev I, Chieffo A, Airoldi F, Carlino M, Montorfano M, Colombo A. Early outcome of treatment of ostial de novo left anterior descending coronary artery lesions with drug-eluting stents. Am J Cardiol 2006; 97:187-91. [PMID: 16442360 DOI: 10.1016/j.amjcard.2005.07.131] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2005] [Revised: 07/27/2005] [Accepted: 07/27/2005] [Indexed: 11/19/2022]
Abstract
We investigated early and mid-term clinical and angiographic outcomes of patients who had de novo ostial left anterior descending coronary artery (LAD) lesions that were treated with drug-eluting stents (DESs) or bare metal stents (BMSs). We identified 43 consecutive patients who underwent percutaneous intervention for isolated de novo ostial LAD lesions with implantation of DESs and compared them with 43 patients who had similar lesions that were treated with BMSs. All stents were successfully implanted. There were no significant differences with respect to major in-hospital complications between the 2 groups. One patient in the BMS group died during hospitalization. Non-Q-wave myocardial infarction occurred in 2 patients (4.7%) in the DES and in 1 patient (2.3%) in the BMS group. At 9-month follow-up, 3 patients (7%) in the DES group and 11 (25.6%) in the BMS group underwent target lesion revascularization (p = 0.038); major adverse cardiac events were less frequent in the DES than in the BMS group (9.3% vs 32.6%, p = 0.015). Angiographic follow-up was available in 82% of patients in the DES group and 75% of those in the BMS group (p = 0.6) and showed lower binary restenotic rates (5.7% vs 31.3%, p = 0.01) and smaller late loss (0.30 +/- 0.81 vs 1.23 +/- 0.93 mm, p = 0.0001) in the DES group. In conclusion, DES implantation in de novo ostial LAD lesions appears safe and effective and is associated with a significant decrease in restenotic rates compared with historical experience with BMSs.
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Seung KB, Kim YH, Park DW, Lee BK, Lee CW, Hong MK, Kim PJ, Chung WS, Tahk SJ, Park SW, Park SJ. Effectiveness of Sirolimus-Eluting Stent Implantation for the Treatment of Ostial Left Anterior Descending Artery Stenosis With Intravascular Ultrasound Guidance. J Am Coll Cardiol 2005; 46:787-92. [PMID: 16139126 DOI: 10.1016/j.jacc.2005.06.009] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2005] [Revised: 04/01/2005] [Accepted: 04/25/2005] [Indexed: 11/30/2022]
Abstract
OBJECTIVES This study was designed to evaluate the clinical and angiographic outcomes of sirolimus-eluting stent (SES) implantation for ostial left anterior descending (LAD) lesions compared with bare-metal stent (BMS) implantation. BACKGROUND The effectiveness of SES implantation for ostial LAD lesions is currently unknown. METHODS Sirolimus-eluting stents were implanted in 68 consecutive patients with ostial LAD stenoses. The control group was composed of 77 patients treated with BMS during the preceding two years. In the SES group, for complete lesion coverage, stent positioning was intentionally extended into the distal left main coronary artery (LMCA) in 23 patients (34%) with intermediate LMCA narrowing. RESULTS Compared with the BMS group, the SES group had more multivessel involvement, received fewer debulking atherectomies, underwent more direct stenting, had a greater number of stents, and had more segments stented. The procedural success rate was 100% in both groups. The six-month angiographic restenosis rate was significantly lower in the SES group than in the BMS group (5.1% vs. 32.3%, p < 0.001). During the one-year follow-up period, neither death nor myocardial infarction occurred in either group, but target lesion revascularization was less frequent in the SES group than in the BMS group (0% vs. 17%, p < 0.001). In the SES group, there were no restenoses in cases with LMCA coverage, compared with three restenoses (7.9%) in cases with precise stent positioning (p = NS). CONCLUSIONS Sirolimus-eluting stent implantation in ostial LAD lesions achieved excellent results regarding restenosis and clinical outcomes compared with BMS implantation. This finding may be associated with reduced neointimal hyperplasia and complete lesion coverage.
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Huang HL, Hsieh IC, Chang SH, Chang HJ, Chen CC, Hung KC, Wen MS, Wu D. Acute and long-term outcomes of intracoronary stenting in aorto-ostial, left anterior descending artery-ostial and nonostial stenoses. Int J Cardiol 2005; 101:391-7. [PMID: 15907406 DOI: 10.1016/j.ijcard.2004.03.055] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2003] [Revised: 02/03/2004] [Accepted: 03/05/2004] [Indexed: 10/26/2022]
Abstract
Percutaneous transluminal coronary angioplasty in ostial lesions is technically difficult and is associated with a lower procedural success rate, higher complication rate and restenosis rate as compared to nonostial lesions. The safety, feasibility, immediate and 6-month angiographic, and long-term clinical outcomes of stenting in aorto-ostial, left anterior descending artery (LAD)-ostial and nonostial stenoses, were retrospectively compared in 19 patients with 20 aorto-ostial lesions (group A), 97 with 97 LAD-ostial lesions (group B) and 1778 with 2242 nonostial lesions (group C). The major adverse cardiac events during hospitalization were similar among the three groups (p = 0.816). Twelve patients with 12 lesions in group A, 75 with 75 lesions in group B and 1384 with 1749 lesions in group C underwent a 6-month follow-up coronary angiography. There were no differences in acute gain (2.04 +/- 0.46 vs. 2.34 +/- 0.50 vs. 2.39 +/- 0.54 mm, respectively, p = 0.057) and net gain (0.89 +/- 1.02 vs. 1.26 +/- 1.08 vs. 1.34 +/- 0.76 mm, respectively, p = 0.105) among the three groups. Group B had a larger late loss than group A and C (1.15 +/- 1.01 vs. 1.22 +/- 0.76 vs. 1.04 +/- 0.65 mm, respectively, p = 0.048) and group A had a larger loss index than group B and C (0.59 +/- 0.50 vs. 0.52 +/- 0.31 vs. 0.48 +/- 0.29, respectively, p = 0.027). The binary restenosis rate among the three groups was 33%, 29% and 20%, respectively, (p = 0.072). Group B had higher restenotic rate as compared to group C (p = 0.036). During a long-term follow-up period of 42+/-21 months, major adverse cardiac events were similar among the three groups (15.8% vs. 25.8% vs. 20.1%, respectively, p = 0.362), but group B had a higher incidence of recurrent angina as compared to group C (17.5% vs. 10.9%, p = 0.039). The cardiac event-free survival rate, as determined by Kaplan-Meier analysis, was similar among the three groups (56% vs. 57% vs. 67%, respectively, p = 0.149); a borderline significance was noted as compared group B to group C (p = 0.051). In conclusion, stenting in aorto-ostial or LAD-ostial lesions is safe, feasible and has a similar acute result as compared to stenting in nonostial lesions; however, it still has a higher 6-month angiographic restenosis rate. LAD-ostial stenoses may have a less favorable long-term clinical outcome than nonostial stenoses.
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Affiliation(s)
- Hsuan-Li Huang
- Second Section of Cardiology, Department of Medicine, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taipei, Taiwan
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16
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Kim YH, Hong MK, Lee SW, Lee CW, Han KH, Kim JJ, Park SW, Mintz GS, Park SJ. Randomized comparison of debulking followed by stenting versus stenting alone for ostial left anterior descending artery stenosis: intravascular ultrasound guidance. Am Heart J 2004; 148:663-9. [PMID: 15459598 DOI: 10.1016/j.ahj.2004.05.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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.
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Affiliation(s)
- Young-Hak Kim
- Department of Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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Mavromatis K, Ghazzal Z, Veledar E, Diamandopoulos L, Weintraub WS, Douglas JS, Kalynych AM. Comparison of outcomes of percutaneous coronary intervention of ostial versus nonostial narrowing of the major epicardial coronary arteries. Am J Cardiol 2004; 94:583-7. [PMID: 15342287 DOI: 10.1016/j.amjcard.2004.05.020] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2004] [Revised: 05/18/2004] [Accepted: 05/18/2004] [Indexed: 11/24/2022]
Abstract
Outcomes of percutaneous coronary intervention (PCI) of the ostia of the major epicardial coronary arteries in the modern era of stenting have not been clearly defined. We evaluated data from all PCIs performed from 1998 to 2001 in the proximal segments of the major epicardial coronary arteries entered into a large cardiac database and compared ostial with nonostial PCI outcomes. Of 2,484 patients who underwent PCI of a proximal coronary artery (left anterior descending, left circumflex, or right coronary), 223 patients had ostial narrowing and 2,261 patients had proximal, nonostial narrowing. Baseline characteristics were similar between the 2 groups, except that patients with ostial narrowing tended to be older and have shorter narrowings than did patients with nonostial narrowings. Stenting occurred in 89% of all patients and was similar in patients with ostial or nonostial narrowings. Procedural success was the same for ostial and nonostial PCI (96% vs 95%, p = 0.95). One-year event-free survival rate was lower in patients who underwent ostial PCI (69% vs 80%, p = 0.0019), largely due to a greater need for repeat PCI (19% vs 10%, p <0.0001). Multivariate analysis showed that ostial location, age, angina class, and number of diseased vessels were independent predictors of the occurrence of cardiac events. PCI of ostial narrowings of the major epicardial coronary arteries was relatively safe. However, at 1 year, patients who underwent ostial PCI had an increased rate of repeat revascularization compared with patients who underwent nonostial, proximal PCI.
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Affiliation(s)
- Kreton Mavromatis
- Division of Cardiology, Atlanta VA Medical Center, Decatur, Georgia, USA.
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Airoldi F, Di Mario C, Stankovic G, Briguori C, Carlino M, Chieffo A, Liistro F, Montorfano M, Pagnotta P, Spanos V, Tavano D, Colombo A. Clinical and angiographic outcome of directional atherectomy followed by stent implantation in de novo lesions located at the ostium of the left anterior descending coronary artery. Heart 2003; 89:1050-4. [PMID: 12923025 PMCID: PMC1767837 DOI: 10.1136/heart.89.9.1050] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Lesions located at the ostium of the left anterior descending coronary artery (LAD) are considered an ideal target for directional atherectomy (DCA), but few data are available about the value of using this strategy before stenting in comparison with stenting alone. OBJECTIVES To investigate the immediate and mid term clinical and angiographic results of DCA followed by stent implantation for ostial LAD lesions. DESIGN Retrospective comparison of the immediate and mid term angiographic and clinical results of a series of 117 consecutive patients with de novo lesions located at the ostium of the LAD. Of these, 46 underwent DCA before stenting and 71 were treated with stenting alone. RESULTS Technical success in the two groups was similar at around 98%. DCA plus stenting provided a larger minimum lumen diameter at the end of the procedure than stenting alone (3.57 (0.59) mm v 3.33 (0.49) mm, p = 0.022). There were no differences for in-hospital major adverse events (MACE) (7.5% for atherectomy plus stenting, and 5.3% for stenting alone; p = 0.41). All patients had clinical follow up at a mean of 7.9 (2.7) months. Angiographic follow up was done in 89 patients (76%) at a mean of 5.9 (2.2) months. The atherectomy plus stenting group had a larger minimum lumen diameter than the stenting group (2.79 (0.64) mm v 2.26 (0.85) mm, p = 0.004) and a lower binary restenosis rate (13.8% v 33.3%, p = 0.031). Six month MACE were reduced in the atherectomy plus stenting group (8.7% v 23.9%, p = 0.048). CONCLUSIONS Debulking before stenting in de novo lesions located at the ostium of the LAD is safe and is associated with a high rate of technical success. Follow up data show that DCA plus stenting results in a significantly larger minimum lumen diameter and a lower incidence of restenosis than stenting alone.
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Affiliation(s)
- F Airoldi
- EMO Centro Cuore, Columbus Clinic and Interventional Cardiology Unit, San Raffaele Hospital IRCCS, Milan, Italy
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Drenth DJ, Veeger NJGM, Winter JB, Grandjean JG, Mariani MA, Boven van AJ, Boonstra PW. A prospective randomized trial comparing stenting with off-pump coronary surgery for high-grade stenosis in the proximal left anterior descending coronary artery: three-year follow-up. J Am Coll Cardiol 2002; 40:1955-60. [PMID: 12475455 DOI: 10.1016/s0735-1097(02)02536-6] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVES This study was done to identify the best treatment for an isolated high-grade stenosis of the proximal left anterior descending coronary artery (LAD). BACKGROUND Percutaneous transluminal coronary angioplasty with stenting (PCI) and off-pump coronary artery bypass grafting (surgery) are used to treat single-vessel disease of a high-grade stenosis of the proximal LAD. Midterm results of both treatments are compared in this prospective randomized study. METHODS In a single-center prospective trial, we randomly assigned 102 patients with a high-grade stenosis of the proximal LAD (American College of Cardiology/American Heart Association classification type B2 or C) to PCI (n = 51) or surgery (n = 51). Primary composite end point was freedom from Major Adverse Cardiac and Cerebrovascular Events (MACCE) at follow-up, including death, myocardial infarction, cerebrovascular accident, and repeat target vessel revascularization (TVR). Secondary end points were angina pectoris class and need for antianginal medication at follow-up. Analysis was by intention-to-treat (ITT) and received treatment (RT). RESULTS Mean follow-up time was three years (90% midrange, two to four years). Incidence of MACCE was 23.5% after PCI and 9.8% after surgery; p = 0.07 ITT (24.1% vs. 8.3%; p = 0.04 RT). After surgery a significantly lower angina pectoris class (p = 0.02) and need for antianginal medication (p = 0.01) was found compared to PCI. Target vessel revascularization was 15.7% after PCI and 4.1% after surgery (p = 0.09). CONCLUSIONS At three-year follow-up (range, two to four years), a trend in favor of surgery is observed in regard to MACCE-free survival with a significantly lower angina pectoris status and significantly lower need for antianginal medication.
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Affiliation(s)
- Derk J Drenth
- Thoraxcentre of the Groningen University Hospital, Groningen, The Netherlands
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20
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Bramucci E, Repetto A, Ferrario M, Canosi U, Boschetti E, Brambilla N, Gnecchi M, Merlini PA, Ardissino D, Angoli L, Tavazzi L. Effectiveness of adjunctive stent implantation following directional coronary atherectomy for treatment of left anterior descending ostial stenosis. Am J Cardiol 2002; 90:1074-8. [PMID: 12423706 DOI: 10.1016/s0002-9149(02)02772-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The aim of this study was to evaluate the acute and long-term angiographic and clinical results of optimal plaque debulking by means of directional coronary atherectomy (DCA) followed by stent implantation for treatment of left anterior descending (LAD) ostial stenosis. Eighty consecutive patients (66 men; aged 57 +/- 10 years) with angina pectoris, documented anterior myocardial ischemia, and de novo LAD ostial stenosis prospectively underwent DCA and stent deployment. They were evaluated angiographically after 6 months and clinically for up to 30 +/- 29 months. The primary success rate was 98%. The in-hospital complications were 1 death due to in-stent subacute thrombosis 7 days after the procedure, 1 non-Q-wave myocardial infarction, and 1 retrograde left main artery dissection. The angiographic binary restenosis rate was 14.5%, and the loss index was 0.38 +/- 0.35. The target lesion revascularization (TLR) rates at 6, 12, and 24 months were 6.0%, 14.5%, and 16.3%, respectively, and the combined event rates (death, nonfatal myocardial infarction, TLR) at the same times were 8.7%, 17.5%, and 21.2%, respectively. These results indicate that the combined approach of DCA and stent implantation is feasible and safe in patients with LAD ostial lesions, has a high success rate, a low incidence of restenosis, and a good long-term outcome.
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Affiliation(s)
- Ezio Bramucci
- Department of Cardiology, I.R.C.C.S. Policlinico San Matteo, Piazzale Golgi 2, 27100 Pavia, Italy.
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21
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Amodeo VJ, Donias HW, Dancona G, Hoover EL, Karamanoukian HL. The hybrid approach to coronary artery revascularization: minimally invasive direct coronary artery bypass with percutaneous coronary intervention. Angiology 2002; 53:665-9. [PMID: 12463619 DOI: 10.1177/000331970205300606] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In the past decade, new developments in cardiology and cardiac surgery have begun to offer patients a variety of new, less invasive options for the treatment of coronary artery disease. One such option is the hybrid approach to coronary artery revascularization. This combines minimally invasive direct coronary artery bypass surgery (MIDCAB) of the left anterior descending artery (LAD) with percutaneous coronary intervention (PCI) of the remaining diseased coronary arteries. This approach, as an alternative to conventional coronary artery bypass surgery, retains the benefit of internal mammary artery bypass to the LAD, accomplished with a minimally invasive technique, substitutes PCI for saphenous vein grafts as treatment for low-grade lesions of other coronary arteries, and may provide a maximally beneficial outcome for many patients. Preliminary outcomes of patients receiving the hybrid approach have been strikingly positive. This report highlights the rationale for the development of this procedure, patient selection, results, and future applications of this emerging method of treating coronary artery disease.
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Affiliation(s)
- Victoria J Amodeo
- State University of New York at Buffalo School of Medicine and Biomedical Sciences, USA
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22
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Drenth DJ, Winter JB, Veeger NJGM, Monnink SHJ, van Boven AJ, Grandjean JG, Mariani MA, Boonstra PW. Minimally invasive coronary artery bypass grafting versus percutaneous transluminal coronary angioplasty with stenting in isolated high-grade stenosis of the proximal left anterior descending coronary artery: six months' angiographic and clinical follow-up of a prospective randomized study. J Thorac Cardiovasc Surg 2002; 124:130-5. [PMID: 12091818 DOI: 10.1067/mtc.2002.122525] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE We sought to compare minimally invasive coronary artery bypass grafting (surgical intervention) with percutaneous transluminal coronary angioplasty with primary stenting (stenting) in patients having an isolated high-grade stenosis (American College of Cardiology/American Heart Association classification type B2 or C) of the proximal left anterior descending coronary artery. At 6 months, both procedures were compared on the basis of quantitative angiography and clinical outcome. METHODS Both treatments were compared in a single-center, prospective, randomized study. The primary end point of this study was quantitative angiographic outcome at 6 months. The secondary end point was 6-month clinical outcome. Statistical analysis was performed in accordance with the intention-to-treat principle. RESULTS From March 1997 to September 1999, patients with angina pectoris caused by an isolated high-grade stenosis of the proximal left anterior descending coronary artery were randomly assigned to surgical intervention (n = 51) or stenting (n = 51). At 6 months, quantitative coronary angiography showed an anastomotic stenosis rate of 4% after surgical intervention and a restenosis rate of 29% after stenting (P <.001). Periprocedural events did not significantly differ between surgical intervention and stenting. After surgical intervention, 2 patients died; no patients died after stenting. After 6 months, no significant difference was found for major adverse cardiac or cerebral events and need for repeat target vessel revascularization. After 6 months, return of angina pectoris, physical work capacity, and use of antianginal drugs did not significantly differ between treatments. CONCLUSIONS After 6 months, surgical intervention had a significantly better angiographic outcome than stenting in patients with an isolated high-grade stenosis of the proximal left anterior descending coronary artery. Clinical outcome did not significantly differ between treatments.
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Affiliation(s)
- Derk J Drenth
- Thoraxcentre of the Groningen University Hospital, Groningen, The Netherlands
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23
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Leborgne L, Cheneau E, Wolfram R, Ajani A, Pakala R, Canos D, Pinnow E, Pichard AD, Satler LF, Waksman R. The proximal location of stenosis in the left anterior descending coronary artery is not a predictive factor of worse outcome in the era of the stent. CARDIOVASCULAR RADIATION MEDICINE 2002; 3:127-32. [PMID: 12974362 DOI: 10.1016/s1522-1865(03)00095-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Patients treated for lesions in the proximal left anterior descending coronary artery (P-LAD) have worse outcome after balloon angioplasty as compared to patients treated for lesions in the distal left anterior descending coronary artery (D-LAD). We sought to examine if this discrepancy was still observed after stenting. METHODS A total of 676 consecutive patients with a symptomatic monovessel disease in the LAD artery who underwent angioplasty with stenting were prospectively entered into a dedicated database. Among this cohort, 322 lesions were located in P-LAD and 354 in D-LAD. Patients with total occlusion, acute myocardial infarction (MI) or restenosis were excluded. RESULTS Procedural characteristics were similar in the two groups. Procedural success was high with the same rates of in-hospital death and Q-wave MI for patients treated in P-LAD and D-LAD. At 1 year, the rate of target lesion revascularization (TLR) was 13.9% in the P-LAD group and 16.3% in the D-LAD group (P = .79), and the rate of event-free survival was 81.9% and 81% (P = .67), respectively. The treatment of ostial lesions (n = 23) was not related to worse outcome. In multivariate analysis, lesion location was not a predictor of major adverse cardiac events (MACE). CONCLUSION This study shows that stenting of lesions in the P-LAD is as effective and safe as treatment of lesions located in D-LAD. Therefore, when stenting is feasible, the location of the lesion in the LAD is not predictive of worse outcome and, consequently, should not be taken into account in the choice of the revascularization strategy.
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Affiliation(s)
- Laurent Leborgne
- Division of Cardiology, Cardiovascular Research Institute, Washington Hospital Center, Suite 4B-1, 110 Irving Street, NW, Washington, DC 20100, USA
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Valencia J, Bordes P, Berenguer A, Mainar V, Ruiz Nodar JM, Arrarte V. [Long-term follow-up of patients with proximal left anterior descending coronary artery stenosis treated with stent]. Rev Esp Cardiol 2002; 55:607-15. [PMID: 12113719 DOI: 10.1016/s0300-8932(02)76668-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION AND OBJECTIVE Patients with lesions of the proximal left anterior descending coronary artery are a special high-risk group. In the present study we analyzed the efficacy and safety of coronary stenting in such lesions and the factors related to a less favorable prognosis in long-term follow-up. METHODS Ninety-eight consecutive patients with severe left anterior descending artery stenosis were enrolled, all with coronary angioplasty and elective stenting. Clinical follow-up was carried out annually in all patients by personal interview or telephone contact. The incidence of death, new infarction, anginal status, and new revascularization procedures was registered. Clinical, angiographic, and procedural variables were analyzed to identify predictors of long term prognosis. RESULTS Mean follow-up was 38 11 months. There was only one major periprocedural complication, which required urgent surgery. Five deaths were registered, 3 of non-cardiac and 2 of cardiac origin. Twenty-five patients developed angina and 11 underwent a new revascularization of the proximal left anterior descending coronary artery (6 surgical and 5 angioplasty). Two patients had new anterior myocardial infarction. At 60 months the major cardiac event-free rate was 83.7% and the cardiac death-free rate was 98%. The use of two stents and the association of diabetes-hypertension-hypercholesterolemia were associated with a less favorable prognosis in our population. CONCLUSIONS Stenting of left anterior descending coronary stenosis was safe and effective in a long-term analysis. The survival rate was high and the incidence of new revascularization was low.
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Affiliation(s)
- José Valencia
- Laboratorio de Hemodinámica. Servicio de Cardiología. Hospital General Universitario de Alicante. Spain.
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25
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Affiliation(s)
- Dale T Ashby
- Cardiovascular Research Foundation, New York, New York 10022, USA
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