Directional atherectomy prior to stenting in bifurcation lesions: A matched comparison study with stenting alone

The ideal catheter-based intervention for treatment of coronary lesions at bifurcation site still has to be defined. The aim of the study was to asses s the acute and long-term outcome after treatment of bifurcation lesions wi th directional atherectomy (DCA) and stenting in comparison with stenting a lone. Thirty-one consecutive patients treated for bifurcation coronary lesi ons (62 lesions) with DCA and stenting in at least one branch (DCA group) w ere compared with a matched group of 31 patients with bifurcation coronary lesions (62 lesions) treated with stenting alone in at least one branch (no n-DCA group). Procedural success was 87.1% in the DCA group compared with 1 00% in the non-DCA group (P = 0.03). In-hospital major adverse cardiac even ts (MACE) occurred only in the DCA group (12.9% vs. 0%, P = 0.03), mainly n on-Q-wave myocardial infarction, After the procedure, minimum lumen diamete r (MLD) and acute gain were significantly greater (P = 0.004 and P = 0.05, respectively) and % diameter stenosis was significantly lower (P = 0.05) in the main branch in the DCA group. At follow-up angiogram, MLD in the main branch was still significantly greater in the DCA group compared to the non -DCA group (2.31 vs. 1.65, respectively, P = 0.04), with no significant dif ference in late loss and loss index between the two groups. Restenosis rate was 28.8% in the DCA group vs. 43.5% in the non-DCA group (P = 0.13). The incidence of follow-up MACE was 29% in the DCA group compared with 48.4% in the non-DCA group, mainly due to target lesion revascularization. In concl usion, treatment of bifurcation coronary lesions with DCA and stenting was associated with greater acute gain after the procedure and greater MLD at f ollow-up in the main branch compared with stenting alone. Procedural myocar dial infarction was more frequent in the DCA group. Restenosis rates and fo llow-up MACE were lower following DCA and stenting, without reaching any st atistical significance. Cathet Cardiovasc Intervent 2001;53:12-20, (C) 2001 Wiley-Liss, Inc.