ADVANTAGE OF STENTS IN THE MOST PROXIMAL LEFT ANTERIOR DESCENDING CORONARY-ARTERY

Objectives Balloon angioplasty of the proximal left anterior descendin g artery is associated with a high rate of restenosis. We hypothesized that the significant reduction in restenosis rates demonstrated by st ent implantation in the coronary arteries in general would be especial ly prominent in the most proximal left anterior descending coronary ar tery. Methods We reviewed 65 consecutive patients in whom stents were placed in the most proximal left anterior descending artery between Ma rch 1990 and July 1995 and compared them with 56 consecutive patients with angioplasty. Minimum luminal diameter was measured angiographical ly before, after, and 6 months after the intervention. We compared the change in minimum luminal diameter and restenosis rate between the pa tients with stents and the patients with angioplasty to clarify the re sponse of this important artery to these different procedures.Results There was 6-month angiographic follow-up of the treated lesion in 99% of the patients The postpracedure minimum luminal diameter, acute gain , and minimum luminal diameter at follow-up were greater in arteries t reated with stents than in those created with balloons. Of importance, late loss was not significantly different between the two groups afte r treatment at this site. Thus the restenosis rate after angioplasty w as 52% compared with 20% after stent implantation (p < 0.001). Conclus ions Stent implantation in the most proxima left anterior descending a rtery is associated with an even greater reduction in restenosis rate than implantations elsewhere in the coronary arteries. This enhanced r eduction in restenosis appears to be due to an unusually large amount of late loss after angioplasty at this site.