Isolated coronary ostial stenosis: observations on the pathology

Stewart, Jim; Ward, David; Davies, Michael J.; Pepper, John

doi:10.1093/oxfordjournals.eurheartj.a062359

Cited by 55 publications

(27 citation statements)

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“…Information gained from pathologic series has shown that ostial lesions are frequently heavily calcified, sclerotic and fibrotic compared to non-ostial lesions [7, 8]. This lesion rigidity may explain the high restenosis rates seen in this group and the frequent poor response to expansion, which often necessitates rotational atherectomy [7].…”

Section: Discussionmentioning

confidence: 99%

Comparison of Bare-Metal and Sirolimus- or Paclitaxel-Eluting Stents for Aorto-Ostial Coronary Disease

Barlis¹,

Kaplan²,

Dimopoulos³

et al. 2008

Cardiology

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Objectives: Aorto-ostial lesions (AOL) are technically challenging, given their greater propensity to be calcific and associated with elastic recoil compared to non-ostial lesions. This study set out to assess angiographic and clinical outcomes in patients with AOL treated using either paclitaxel-eluting stents (PES) or sirolimus-eluting stents (SES) compared to bare-metal stent (BMS) implantation. Methods: We retrospectively identified 175 consecutive patients with 175 AOL involving the left main, right coronary artery or bypass graft. PES, SES and BMS were implanted in 69, 50 and 56 patients, respectively. Results: Angiographic and procedural success was 100 and 97.1% for PES, 100 and 94% for SES, and 100 and 94.6% for BMS, respectively (p not significant). At 12 months, the rates of target lesion (8.7% for PES, 4.0% for SES) and target vessel revascularization (3.0% for PES, 8.0% for SES) were significantly lower in the drug-eluting stent group compared to BMS (32.1 and 35.7%, respectively). There was no difference in the rate of death/MI in the BMS versus drug-eluting stent groups (5.4 vs. 2.4%, p = 0.32). Conclusions: In the treatment of AOL, drug-eluting stents reduce the need for repeat revascularization at 12 month follow-up compared to BMS, with no difference in mortality or MI rate.

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Section: Discussionmentioning

confidence: 99%

Comparison of Bare-Metal and Sirolimus- or Paclitaxel-Eluting Stents for Aorto-Ostial Coronary Disease

Barlis¹,

Kaplan²,

Dimopoulos³

et al. 2008

Cardiology

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“…1,3 Although ostial lesions were not examined pathologically in the present study, punch biopsies of the ascending aortic wall were performed during operation in a few cases of IOS and the results were nonspecific and not helpful for identifying the pathological etiologic factors. However, our findings do not agree with other published results showing that IOS is often atheromatous, because in the present patients with IOS progression of atherosclerosis was not recognized and they had fewer coronary risk factors.…”

Section: Discussionmentioning

confidence: 90%

Long-Term Clinical and Angiographic Follow-up in Patients With Isolated Ostial Stenosis of the Left Coronary Artery

Arima

Kanoh

Okazaki

et al. 2009

Circ J

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solated ostial stenosis (IOS) of the left coronary artery (LCA), in the absence of distal vessel obstruction, is a rare form of coronary artery disease. It is neither associated with Takayasu arteritis, syphilitic aortitis, congenital anomaly, aortic valve disease nor iatrogenic cause such as mediastinal irradiation or cardiac surgery. Atherosclerosis, particularly early atheroma, has been considered its most likely cause, but its etiology is quite unknown. In such cases the occurrence has usually been in premenopausal women, 1 and the clinical profile might differ from that of the more common atherosclerotic stenosis of the left main trunk (LMT). 2 The clinical features of patients with IOS have gradually come to light, but the long-term prognosis and serial angiographic follow-up in patients with IOS who undergo coronary artery bypass grafting (CABG) have not been fully studied. Methods Study PopulationWe investigated 57 patients with stenosis of the LMT who underwent CABG. They underwent coronary angiography and subsequently treatment for myocardial ischemia before 1994. All patients underwent CABG at Juntendo University and were followed at Juntendo University Urayasu Hospital. They were categorized into 3 groups based on the angiographic findings: Group I comprised 9 patients with IOS ( Figure 1A); Group II comprised 12 patients with LCA ostial stenosis in the presence of distal vessel obstruction ( Figure 1B); Group III comprised 36 patients with stenosis of the LMT excluding ostial stenosis, and associated with distal vessel obstruction ( Figure 1C). We studied the coronary risk factors and prognosis in all patients. Hypercholesterolemia was defined as a requirement for antihyperlipidemic drugs or a total cholesterol (TC) level >220 mg/dl. Diabetes mellitus (DM) was defined as a requirement for therapy and/or with a fasting blood sugar >140 mg/dl, and/or a blood sugar >200 mg/dl on occasion. Baseline clinical and procedural data were collected for all patients. Coronary AngiographyThe patients underwent serial angiography at 1, 5, and 10 years after CABG, regardless of their symptoms, under informed consent. The films were of good quality and the repeat studies were always compared with the baseline coronary arteriogram. The films were read on 2 adjacent projectors by 2 angiographers working together to reach a consensus. The stenosis of the coronary arteries and grafts were defined as the linear percentage of narrowing of the diameter of the vessel compared with the diameter of the nearest normal segment. The severity of the stenosis was evaluated according to the American Heart Association Committee Report. In this study, graft patency was considered to be widely patent or the presence of stenosis <99% narrowing. In the follow-up angiography we studied the Long-Term Clinical and Angiographic Follow-up in Patients With Isolated Ostial Stenosis of the Left Coronary ArteryMizuhiro Arima, MD; Tatsuji Kanoh, MD*; Shinya Okazaki, MD*; Yoshitaka Iwama, MD*; Shigeru Matsuda, MD**; Yuji Nakazato, MD** Backgroun...

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“…Furthermore, the base-line diameter % stenosis in the two DES groups was significantly higher than that of the BMS ostial groups, lesion rigidity might be a possible explanation for this finding. Histological data from pathologic series [37] and atherectomy specimens [38] showed that ostial lesions are frequently heavily calcified, fibrotic, and sclerotic.…”

Section: Discussionmentioning

confidence: 99%

Major clinical and angiographic outcome of drug eluting stents in native ostial coronary artery disease

Meguid¹,

Mahmoud²,

Amin³

et al. 2013

WJCD

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Objectives: The study was designed to evaluate the efficacy and safety of drug eluting stents (DESs) in aorto-ostial (A-O) coronary artery lesions, in terms of early and late restenosis rate; including clinical assessment, non-invasive stress testing and angiographic follow-up. Also, the study was aimed to compare the results of implantation of drug eluting stents (DES) to that of bare metal stents (BMS) in aortoostial lesions done over a previous 5 years in Royal Brompton Hospital. Background: The safety and effectiveness of DESs for the treatment of aorto-ostial lesions. Methods: We included 161 consecutive patients with symptoms subjective of angina pectoris or objective evidence of myocardial ischemia; who underwent percutaneous coronary interventions (PCI) in coronary ostial lesions using DES. The patients were divided into two groups based on the site of ostial lesion. The control group consisted of 125 consecutive patients who underwent percutaneous coronary intervention for ostial lesions using bare metal stents (BMS) implantation in the period immediately before the introduction of DES. The incidence of major adverse cardiac events (MACE), including death or Q-wave myocardial infarction (MI), need for repeated revascularization procedure CABG or angioplasty, were recorded in-hospital and at twelve months ± 3 months. Follow-up angiography was only performed in case of recurrent symptoms subjective of myocardial ischemia or if there was objective evidence of myocardial ischemia by stress testing. Results: The initial procedure was successful in 149 patients (92.5%) in the DES arm. There were no statistically significant major in-hospital complications in the DES group, compared to BMS group which showed 4 cases of in-hospital deaths (p = 0.017). At Twelve months ± 3 months follow-up, MACE were significantly less frequent in the DES group compared to the BMS group, including death (0.8% vs. 6.4%, p = 0.004) and need for CABG (1.7% vs. 10%, p = 0.012). Conclusions: The main finding of our study is that, compared to the BMS, implantation of the DES in coronary ostial lesions appears safe and effective. It is associated with high procedural success rate, low immediate and in-hospital complication rate, infrequent late adverse events and favourable long-term clinical and angiographic outcomes compared with bare metal stents implantation at 12-month follow-up. Advanced age, previous myocardial infarction and acute coronary syndromes at presentation were all found to be independent positive predictors for clinical events after drug eluting stent implantation in ostial lesions.

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Isolated coronary ostial stenosis: observations on the pathology

Cited by 55 publications

References 0 publications

Comparison of Bare-Metal and Sirolimus- or Paclitaxel-Eluting Stents for Aorto-Ostial Coronary Disease

Comparison of Bare-Metal and Sirolimus- or Paclitaxel-Eluting Stents for Aorto-Ostial Coronary Disease

Long-Term Clinical and Angiographic Follow-up in Patients With Isolated Ostial Stenosis of the Left Coronary Artery

Major clinical and angiographic outcome of drug eluting stents in native ostial coronary artery disease

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