Optimal treatment of nonaorto ostial coronary lesions in large vessels: Acute and long-term results

Percutaneous interventions of nonaorto ostial coronary lesions are usually complex, often requiring a combined approach of debulking and stenting, ins ertion of multiple guidewires and long procedure duration. Debulking with a therectomy device preserves side-branch patency by reducing plaque shift wh ile coronary stenting minimizes vessel recoil and restenosis. We retrospect ively evaluated the acute and long-term results of rotational atherectomy ( group R, n = 94), coronary stenting (group S, n = 39), and combination of r otational atherectomy and stenting (group R-S, n = 59) in a total of 192 pa tients with nonaorto ostial lesions. The number of patients with diabetes m ellitus and rest angina was significantly higher in groups S and R-S. Clini cal success rates were high and procedural complication rates were low and comparable in all three groups. Despite the similar reference vessel size a nd preprocedure minimal lumen diameter (MLD), postprocedure MLD showed a tr end toward larger lumen in groups S (3.15 +/- 0.18 mm) and R-S (3.21 +/- 0. 16 mm). Group S had significantly higher incidence of side-branch narrowing (30.7%), requiring intervention (15.4%). At long-term follow-up (mean of 9 +/- 4 months), target lesion revascularization rate was significantly lowe r in groups R-S (11.9%) and S (15.4%) compared to group R (28.9%; P = 0.02) . Our nonrandomized data suggest that stenting with or without rotational a therectomy provides the best long-term approach for the interventional trea tment of nonaorto ostial coronary lesions. The clinical benefit and cost ef fectiveness of performing rotational atherectomy before stent implantation to reduce the incidence of side-branch closure requires further study. (C) 2001 Wiley-Liss, Inc.