Effect of plaque debulking and stenting on short- and long-term outcomes after revascularization of chronic total occlusions

OBJECTIVES We evaluated the effect of plaque burden modification (debulking ) on the short- and long-term clinical outcomes of patients with a totally occluded native coronary artery undergoing successful stent deployment. BACKGROUND Although the primary success rate of crossing a chronic totally occluded coronary artery has improved with the development of new intervent ional devices and guidewires, the rate of acute reocclusion and restenosis remains high. METHODS The in-hospital and late clinical outcomes of 150 patients who had undergone successful stenting of 176 chronic total occlusions were analyzed . After successful crossing of the lesion, 44 patients with 50 lesions unde rwent debulking by laser angioplasty, rotational or directional atherectomy followed by stenting, whereas 106 patients with 126 lesions underwent sten t implantation without prior debulking. RESULTS Baseline clinical and angiographic characteristics were similar for the two groups, except for a higher incidence of left anterior descending coronary artery location and longer lesions in the group of patients who un derwent debulking prior to stenting. In-hospital mortality, myocardial infa rction and repeat angioplasty rates were similar for the two groups. At a m ean 14 +/- 8 months follow-up time, there were no deaths in either group, a nd target lesion revascularization rates were the same (16.3% in the debulk ing plus stent group vs. 14.4% in the stent alone group, p = NS). CONCLUSIONS Treatment of chronic total native coronary artery occlusions wi th stent deployment with and without lesion modification (debulking) result s in a favorable in-hospital outcome, with relatively low long-term target lesion revascularization rates. (C) 1999 by the American College of Cardiol ogy.