Does directional coronary atherectomy before stenting improve lumen diameter and reduce restenosis in LAD lesions with ≥3 mm reference vessel diameter compared to stenting alone?
Directional coronary atherectomy prior to stenting in large LAD lesions improves lumen diameter and reduces restenosis, albeit with a higher risk of periprocedural non-Q-wave myocardial infarction.
The present study evaluated acute and late results with stenting following directional coronary atherectomy (DCA) for the lesions in the left anterior descending coronary artery (LAD). Between April 1995 and January 1997, 200 LAD lesions with > or =3 mm reference vessel diameter were treated with coronary stents. The lesions were divided as to whether or not DCA was performed before stenting; 1) stenting alone (n = 163) and 2) debulking and stenting (n = 37). There were no significant differences in the incidences of complications except for non-Q-wave myocardial infarction that was more frequent in patients with debulking and stenting than in those with stenting alone (13.5% vs. 2.4%, P or =3 mm reference vessel diameter.
Kobayashi et al. (Thu,) studied this question.