STENTING AFTER OPTIMAL LESION DEBULKING (SOLD) REGISTRY - ANGIOGRAPHIC AND CLINICAL OUTCOME

Background-Coronary stenting has reduced restenosis in focal de novo l esions, but its impact has been less pronounced in complex lesion subs ets. Preliminary data suggest a role for plaque burden in promoting in timal hyperplasia after stent implantation. The aim of this study was to test the hypothesis that plaque removal with directional atherectom y before stent implantation may lower the intensity of late neointimal hyperplasia, reducing the incidence of in-stent restenosis. Methods a nd Results-Seventy-one patients with 90 lesions underwent directional atherectomy before coronary stenting. Intravascular ultrasound-guided stenting was performed in 73 lesions (81%). Clinical success was achie ved in 96% of patients. Procedural complications were as follows: emer gency bypass surgery in I patient (1.4%), who died 2 weeks later; Q-wa ve myocardial infarction in 2 patients (2.8%); and non-Q-wave myocardi al infarction in 8 patients (11.3%). None of the patients had stent th rombosis at follow-up. Angiographic follow-up was performed in 89% of eligible patients at 5.7+/-1.7 months. Loss index was 0.33 (95% CI, 0. 26 to 0.40), and angiographic restenosis was 11% (95% CI, 5% to 20%). Clinical follow-up was performed in all patients at 18+/-3 months. Tar get lesion revascularization was 7% (95% CI, 3% to 14%). Conclusions-D irectional atherectomy followed by coronary stenting could be performe d with good clinical success rate. Also, these data point to a possibl e reduction in angiographic restenosis and a significant reduction in the need for repeated coronary interventions. Therefore, a randomized clinical trial seems appropriate to lest the validity of this approach .