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

Objectives. This prospective case control study evaluated the acute and lon g-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 th e incidence of restenosis. Optimal stent deployment is a pivotal factor for achieving the best results, but the bulk of the atherosclerotic plaque opp oses 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-Schat z stent implantation was attempted in 100 patients. The successes, complica tions and angiographic results of the combined procedure were evaluated bot h acutely and during follow up. Matched patients undergoing successful Palm az-Schatz stent implantation alone during the same period served as control s. Results. Atherectomy followed by stent implantation was performed in 94 pat ients with 98 lesions; periprocedural complications were observed in four c ases. 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 ex perienced myocardial infarction, but three patients under went target lesio n revascularization. The patients undergoing stent implantation alone achie ved smaller acute gains, tended to have a higher late lumen loss, had a hig her restenosis rate (30.5% vs. 6.8%, p < 0.0001) and showed a greater incid ence of clinical events during follow up (p < 0.0001). Conclusions. Debulking atherosclerotic lesions by means of directional coro nary atherectomy before stent implantation is a safe procedure with a high success rate and a low incidence of restenosis at follow-up. (J Am Coll Car diol 1998;32:1855-60) (C) 1998 by the American College of Cardiology.