Key result
Directional atherectomy and stenting for bifurcation lesions yielded greater follow-up minimum lumen diameter than stenting alone, but higher in-hospital MACE (12.9% vs 0%, P=0.03).
Why the study?
Does directional atherectomy prior to stenting improve acute and long-term outcomes compared to stenting alone in patients with bifurcation coronary lesions?
Cohort (n=62)
Does directional atherectomy prior to stenting improve acute and long-term outcomes compared to stenting alone in patients with bifurcation coronary lesions?
Absolute Event Rate: 87.1% vs 100%
p-value: p=0.03
Directional atherectomy prior to stenting for bifurcation lesions improves follow-up minimum lumen diameter but is associated with higher periprocedural complications compared to stenting alone.
Warrants caution with directional atherectomy in bifurcations due to higher MACE; leaves open long-term benefits in randomized trials.
The ideal catheter-based intervention for treatment of coronary lesions at bifurcation site still has to be defined. The aim of the study was to assess the acute and long-term outcome after treatment of bifurcation lesions with directional atherectomy (DCA) and stenting in comparison with stenting alone. Thirty-one consecutive patients treated for bifurcation coronary lesions (62 lesions) with DCA and stenting in at least one branch (DCA group) were compared with a matched group of 31 patients with bifurcation coronary lesions (62 lesions) treated with stenting alone in at least one branch (non-DCA group). Procedural success was 87.1% in the DCA group compared with 100% in the non-DCA group (P = 0.03). In-hospital major adverse cardiac events (MACE) occurred only in the DCA group (12.9% vs. 0%, P = 0.03), mainly non-Q-wave myocardial infarction. After the procedure, minimum lumen diameter (MLD) and acute gain were significantly greater (P = 0.004 and P = 0.05, respectively) and % diameter stenosis was significantly lower (P = 0.05) in the main branch in the DCA group. At follow-up angiogram, MLD in the main branch was still significantly greater in the DCA group compared to the non-DCA group (2.31 vs. 1.65, respectively, P = 0.04), with no significant difference in late loss and loss index between the two groups. Restenosis rate was 28.8% in the DCA group vs. 43.5% in the non-DCA group (P = 0.13). The incidence of follow-up MACE was 29% in the DCA group compared with 48.4% in the non-DCA group, mainly due to target lesion revascularization. In conclusion, treatment of bifurcation coronary lesions with DCA and stenting was associated with greater acute gain after the procedure and greater MLD at follow-up in the main branch compared with stenting alone. Procedural myocardial infarction was more frequent in the DCA group. Restenosis rates and follow-up MACE were lower following DCA and stenting, without reaching any statistical significance.
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Karvouni et al. (2001) conducted a cohort in bifurcation coronary lesions (n=62). Directional atherectomy (DCA) and stenting vs. Stenting alone was evaluated on Procedural success (p=0.03). Directional atherectomy and stenting for bifurcation lesions yielded greater follow-up minimum lumen diameter than stenting alone, but higher in-hospital MACE (12.9% vs 0%, P=0.03).
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