Document Detail

Pre-drug-eluting stent debulking of bifurcated coronary lesions.
MedLine Citation:
PMID:  17996557     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: The purpose of this study was to evaluate the efficacy of plaque debulking by directional coronary atherectomy (DCA) before drug-eluting stent (DES) implantation for bifurcated coronary lesions. BACKGROUND: The introduction of DES significantly reduces restenosis and repeated revascularization. However, percutaneous coronary intervention of bifurcated lesions using DES alone remains challenging regardless of whether simple or complex stenting is used. METHODS: Patients with bifurcated lesions were recruited in this prospective multicenter registry. Pre-DES plaque debulking by DCA was conducted. All patients were scheduled to undergo a 9-month coronary angiography. The primary end point was the 9-month binary angiographic restenosis rate. Secondary end points included procedure-related events and major adverse cardiac events (MACE) at 1 year. RESULTS: A total of 99 patients with bifurcated lesions were enrolled in this registry. Directional coronary atherectomy was performed successfully in all cases without any major procedure-related events. Simple stenting was achieved in all but 2 cases. No in-hospital MACE were observed. The 9-month binary restenosis rates in the main branch and side branch were 1.1% and 3.4%, respectively. Target lesion revascularization was performed in 2 patients (1 for the main branch and the other for the side branch). No deaths, no coronary artery bypass grafting, and no myocardial infarctions were reported in the patients within the first year. CONCLUSIONS: Directional coronary atherectomy before DES implantation can possibly avoid complex stenting. This strategy may provide a good long-term outcome in patients with bifurcated lesions.
Etsuo Tsuchikane; Tadanori Aizawa; Hideo Tamai; Yasumi Igarashi; Kenji Kawajiri; Noriyuki Ozawa; Shigeru Nakamura; Koji Oku; Mikihiro Kijima; Takahiko Suzuki;
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Publication Detail:
Type:  Comparative Study; Journal Article; Multicenter Study     Date:  2007-10-29
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  50     ISSN:  1558-3597     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2007 Nov 
Date Detail:
Created Date:  2007-11-12     Completed Date:  2007-12-06     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1941-5     Citation Subset:  AIM; IM    
Department of Cardiology, Toyohashi Heart Center, Aichi, Japan.
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MeSH Terms
Aged, 80 and over
Coronary Stenosis / pathology*,  surgery*
Drug-Eluting Stents*
Follow-Up Studies
Middle Aged
Prospective Studies
Time Factors
Comment In:
J Am Coll Cardiol. 2007 Nov 13;50(20):1946-7   [PMID:  17996558 ]

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