Adjunctive stent implantation following directional coronary atherectomy in patients with coronary artery disease

Ezio Bramucci, Luigi Angoli, Piera Angelica Merlini, Paolo Barberis, Maria Luisa Laudisa, Elisabetta Colombi, Arnaldo Poli, Jaceck Kubica, Diego Ardissino

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Abstract

Objectives. This prospective case-control study evaluated the acute and long-term results of stent implantation preceded by debulking of the plaque by means of directional coronary atherectomy. Background. In comparison with balloon angioplasty, intracoronary stenting produces a larger luminal diameter, maintains artery patency and reduces the incidence of restenosis. Optimal stent deployment is a pivotal factor for achieving the best results, but the bulk of the atherosclerotic plaque opposes stent expansion and may limit the success of the procedure. Debulking of the plaque may provide a better milieu for optimal stent deployment. Methods. Directional coronary atherectomy followed by a single Palmaz-Schatz stent implantation was attempted in 100 patients. The successes, complications and angiographic results of the combined procedure were evaluated both acutely and during follow-up. Matched patients undergoing successful Palmaz-Schatz stent implantation alone during the same period served as controls. Results. Atherectomy followed by stent implantation wag performed in 94 patients with 98 lesions; periprocedural complications were observed in four cases. The stenosis diameter decreased from 76 ± 9% at baseline to 30 ± 13% after atherectomy (p <0.0001), and 5 ± 9% after stent implantation (p <0.0001); it increased to 27 ± 15% at 6-month angiography (p <0.0001). During the 14 ± 10 months of follow-up, none of the patients died or experienced myocardial infarction, but three patients underwent target lesion revascularization. The patients undergoing stent implantation alone achieved smaller acute gains, tended to have a higher late lumen loss, had a higher restenosis rate (30.5% vs. 6.8%, p <0.0001) and showed a greater incidence of clinical events during follow-up (p <0.0001). Conclusions, Debulking atherosclerotic lesions by means of directional coronary atherectomy before stent implantation is a safe procedure with a high success rate and a low incidence of restenosis at follow-up.

Original languageEnglish
Pages (from-to)1855-1860
Number of pages6
JournalJournal of the American College of Cardiology
Volume32
Issue number7
DOIs
Publication statusPublished - Dec 1998

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ASJC Scopus subject areas

  • Nursing(all)

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Bramucci, E., Angoli, L., Merlini, P. A., Barberis, P., Laudisa, M. L., Colombi, E., Poli, A., Kubica, J., & Ardissino, D. (1998). Adjunctive stent implantation following directional coronary atherectomy in patients with coronary artery disease. Journal of the American College of Cardiology, 32(7), 1855-1860. https://doi.org/10.1016/S0735-1097(98)00485-9