FAVORABLE STRATEGY FOR THE OSTIAL LESION OF THE LEFT ANTERIOR DESCENDING CORONARY-ARTERY - INFLUENCE ON NARROWING OF CIRCUMFLEX CORONARY-ARTERY

We examined the effectiveness of Palmaz-Schatz (P-S) stent and directi onal coronary atherectomy (DCA) in ostial lesions of left anterior des cending arteries (LAD). The P-S stent was implanted in 11 cases at LAD ostial lesions, and DCA was performed in 13 cases. Percent stenosis a nd vessel diameter at the target site and the ostium of the circumflex coronary artery (LCX) were measured before and after the procedure. T he initial success rate was 100% in both groups. No major complication occurred. LAD ostial lesions were improved from 81.3 +/- 3.4% to -8.1 +/- 5.7% by P-S stent and from 82.8 +/- 2.6% to -2.7 +/- 3.9% by DCA. LCX ostial vessel diameter was not changed by DCA (from 3.0 +/- 0.2 m m to 3.1 +/- 0.3 mm); however, it was significantly decreased by P-S s tent (from 2.9 +/- 0.2 mm to 2.6 +/- 0.2 mm, P < 0.01). When the angle of LAD and LCX was less than or equal to 80 degrees from the view of RAO 30 degrees and Caudal 30 degrees, the LCX ostium was significantly narrowed by stenting at LAD ostium (P < 0.01). These findings indicat e that both the P-S stent and DCA are effective and safe therapies for LAD ostial lesions in cases with LAD-LCX angle >80 degrees. In cases with LAD-LCX angle less than or equal to 80 degrees, however, DCA is a favored therapy rather than P-S stenting to avoid narrowing of the LC X ostium. (C) 1998 Wiley-Liss, Inc.