A synergistic approach to optimal stenting - Directional coronary atherectomy prior to coronary artery stent implantation - The AtheroLink registry

OBJECTIVES The AtheroLink registry sought to observe the effect of plaque b urden reduction by directional coronary atherectomy (DCA) prior to stenting on acute lesion success rate, on the clinical success rate and on the inci dence of in-stent restenosis six months after intervention. BACKGROUND Although coronary stenting has reduced restenosis, its effect ha s been less favorable in complex lesions with a high plaque burden that res ults from suboptimal stent expansion. Therefore, plaque removal by DCA may improve the results of coronary stenting. METHODS A total of 167 patients with >60% stenosis in a native coronary art ery of 2.8 to 4.0 mm in diameter were enrolled in 10 study centers on an in tention-to-treat basis. All patients underwent DCA aimed at an optimal resu lt (residual diameter stenosis <20%) followed by stenting. Angiographic fol low-up was performed in 120 (71.8%) patients at 5.3 +/- 2.8 months. RESULTS Lesion success was achieved in 164/167 (98.2%) patients, and the cl inical success rate was 95.2% (159/167 patients). The overall restenosis ra te in the 120 patients with angiographic follow-up nas 10.8% (13/120). inci dence of restenosis was lower (8.4%) in patients with optimal stent deploym ent following DCA compared to patients with a persisting caliber reduction >15% (restenosis rate 15.3.%) and restenosis occurred with a significantly higher frequency (p < 0.04) in distal lesions (37.5%) compared to proximal stenoses (9.0%). CONCLUSIONS This observational multicenter registry points to a potential r eduction in restenosis by a synergistic approach of DCA and stenting perfor med under routinely accessible angiographic guidance. Therefore, multicente r-based randomized clinical trials are clearly warranted to finally clarify the validity of this complex approach versus conventional angioplasty plus stenting. (C) 2000 by the American College of Cardiology.