Long‐Term Clinical Efficacy of Cutting Balloon Angioplasty Followed by Bare Metal Stent Implantation for Treating Ostial Left Anterior Descending Artery Lesions

Abstract

Background: Drug-eluting stents (DES) are superior to bare metal stents (BMS) for treating ostial left anterior descending artery (LAD) lesions, but DES is not suitable for all patients in real life practice. Hypothesis: We hypothesize that cutting balloon angioplasty (CBA) followed by BMS (CBA + BMS) for treating ostial LAD lesions is an alternative strategy. Methods: In our study, 101 consecutive patients (51 with DES and 50 with CBA + BMS) with ostial LAD stenting were included for retrospective investigation between November 2003 and May 2005. The target vessel diameter was ≥ 3.0 mm. Results: We compared the DES group with the CBA + BMS group, the rates of restenosis (10.3% versus 17.9%, p = 0.386), target lesion revascularization (TLR) (5.88% versus 10%, p = 0.487) and major adverse cardiac events (MACE) (7.84% versus 12%, p = 0.525) were similar at 6-8 months angiographic follow-up, but there were higher bleeding events in the DES group (p = 0.033). During a 2-year clinical follow-up, no myocardial infarction occurred in the 2 groups, the rates of TLR (7.84% versus 10%, p = 0.741) and MACE (9.8% versus 12%, p = 0.723) were also similar. The MACE-free survival rate was 90.2% versus 88 % (p = 0.723). Conclusions:The CBA + BMS combination has a good long-term clinical effect in the treatment of ostial LAD lesions; it might be an alternative strategy for patients with contraindication for DES implantation, or patients who cannot endure long-term dual antiplatelet medication, or in elderly patients. IntroductionOstial lesions of the coronary artery are a challenge for interventional cardiologists. Conventional balloon angioplasty is ineffective in treating ostial lesions because of high rates of immediate recoil and long-term restenosis. The higher concentration of elastic and muscle fibers around the ostium is the reason for the recoil after balloon inflations. 1 The restenotic rate occurs in approximately 15%-45% of patients after implantation of bare metal stents (BMS) for treating ostial left anterior descending artery (LAD) lesions. 2,3 Randomized clinical trials have proved that the drug-eluting stent (DES) is superior to BMS in de novo lesions, 4,5 but cardiologists are not yet confident of the long-term safety of DES. 6,7 In addition, DES is not suitable for all patients, especially the elderly or patients with contraindication for DES implantation, or patients who cannot endure long-term dual antiplatelet medication. Cutting balloon angioplasty (CBA) followed by BMS (CBA + BMS) insertion in the treatment