Novel strategy for ostial left anterior descending artery acute myocardial infarction: Combined treatment with directional coronary atherectomy followed by drug‐coated balloon angioplasty

Abstract

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Overview of in‐hospital outcomes in patients undergoing percutaneous coronary intervention with the revived directional coronary atherectomy

“…Second, improved stent expandability and larger acute gain due to lesion modification using DCA may result in a reduced risk of in-stent restenosis in the chronic phase after the index PCI. 3,7 Third, stentless PCI using DCA followed by additional DCB angioplasty is a reasonable treatment strategy even in patients with acute coronary syndrome, [4][5][6]11 especially young female patients with menstruation and/or patients at high bleeding risk who cannot tolerate long-term dual antiplatelet therapy or oral anticoagulants. 19 In particular, based on the DCA/DCB registry conducted in 16…”

“…Second, improved stent expandability and larger acute gain due to lesion modification using DCA may result in a reduced risk of in‐stent restenosis in the chronic phase after the index PCI 3,7 . Third, stentless PCI using DCA followed by additional DCB angioplasty is a reasonable treatment strategy even in patients with acute coronary syndrome, 4–6,11 especially young female patients with menstruation and/or patients at high bleeding risk who cannot tolerate long‐term dual antiplatelet therapy or oral anticoagulants 19 . In particular, based on the DCA/DCB registry conducted in 16 Japanese hospitals, Kitani et al 4 reported that a non‐stent PCI strategy using DCA followed by additional DCB angioplasty in patients with bifurcation lesions provided favorable midterm clinical outcomes with low restenosis and target lesion revascularization rates (2.3% and 3.1%, respectively) at the 12‐month follow‐up ( n = 129).…”

“…The design and structure of the novel DCA catheter, including a smaller diameter that is compatible with a 7‐Fr guiding catheter, have been refined compared with the former device 2 . Currently, several clinical experiences of the novel DCA catheter have been reported 5,6,9–14 . Particularly for coronary bifurcation lesions, Japanese multicenter registry‐based studies have revealed the safety and efficacy of DCA before second‐generation drug‐eluting stent (DES) implantation 3 or additional drug‐coated balloon (DCB) angioplasty after DCA without stent implantation 4 with low midterm adverse event rates.…”

“…2 Currently, several clinical experiences of the novel DCA catheter have been reported. 5,6,[9][10][11][12][13][14] Particularly for coronary bifurcation lesions, Japanese multicenter registry-based studies have revealed the safety and efficacy of DCA before second-generation drug-eluting stent (DES) implantation 3 or additional drug-coated balloon (DCB) angioplasty after DCA without stent implantation 4 with low midterm adverse event rates. These recent studies support the utility of DCA with or without a DES and/ or DCB, even in the era of new-generation DESs.…”