Gianluca Rigatelli1, Marco Zuin2, Enrico Baracca3, Paola Galasso3, Mauro Carraro3, Alberto Mazza4, Daniela Lanza3, Loris Roncon3, Ramesh Daggubati5. 1. Cardiovascular Diagnosis and Endoluminal Interventions Unit, Rovigo General Hospital, Rovigo, Italy. Electronic address: jackyheart71@yahoo.it. 2. Section of Internal and Cardiopulmonary Medicine, University of Ferrara, Ferrara, Italy; Division of Cardiology, Rovigo General Hospital, Rovigo, Italy. 3. Division of Cardiology, Rovigo General Hospital, Rovigo, Italy. 4. Department of Medical Sciences, Rovigo General Hospital, Rovigo, Italy. 5. Interventional Cardiology Department, Whintorp Hospital, New York, NY, USA.
Abstract
BACKGROUND: The optimal strategy for treating ostial left anterior descending coronary artery (LAD) disease remains matter of speculation. We evaluated the impact on long-term outcomes of ostial LAD disease treated by means of ostial stenting (the floating-stent) or left main (LM)-to-LAD cross-over stenting. METHODS: Clinical and instrumental records of 74 consecutive patients with isolated ostial LAD disease, enrolled between the 1st January 2012 and the 1st January 2017 were reviewed. Patients have been stratified according the stenting techniques adopted: ostial stenting (OS) or LM cross-over (CO). RESULTS: Seventy-four consecutive patients (54 males, mean age 73.39 ± 9.54 years old) have been analyzed. In CO patients the SYNTAX score (16.2 ± 3.3 vs 24.1 ± 2.5, p < 0.0001) and the percentages of rotablation resulted higher than in OS group. IVUS has been predominantly used in CO groups revealing a significant extension of plaque burden of at least 10 mm of LM proximal to the LAD ostium in all the 18 out of 21 patients (85.7%) undergone IVUS-guided procedure. Fluoroscopy time and contrast medium volume were higher in OS versus CO group of patients. On a mean follow-up of 49.7 ± 7.9 months, MACE and target vessel revascularization (TVR) were 21.0% and 21.0% in OS groups versus 10.1 and 5.6% in the CO group (p = 0.20 and p = 0.04, respectively). Restenosis was higher in the OS than in CO group of patients and was located angiographically at the ostium. CONCLUSIONS: On long-term follow-up CO seems to be superior to OS technique for isolated ostial LAD disease especially in the presence of heavy calcification.
BACKGROUND: The optimal strategy for treating ostial left anterior descending coronary artery (LAD) disease remains matter of speculation. We evaluated the impact on long-term outcomes of ostial LAD disease treated by means of ostial stenting (the floating-stent) or left main (LM)-to-LAD cross-over stenting. METHODS: Clinical and instrumental records of 74 consecutive patients with isolated ostial LAD disease, enrolled between the 1st January 2012 and the 1st January 2017 were reviewed. Patients have been stratified according the stenting techniques adopted: ostial stenting (OS) or LM cross-over (CO). RESULTS: Seventy-four consecutive patients (54 males, mean age 73.39 ± 9.54 years old) have been analyzed. In CO patients the SYNTAX score (16.2 ± 3.3 vs 24.1 ± 2.5, p < 0.0001) and the percentages of rotablation resulted higher than in OS group. IVUS has been predominantly used in CO groups revealing a significant extension of plaque burden of at least 10 mm of LM proximal to the LAD ostium in all the 18 out of 21 patients (85.7%) undergone IVUS-guided procedure. Fluoroscopy time and contrast medium volume were higher in OS versus CO group of patients. On a mean follow-up of 49.7 ± 7.9 months, MACE and target vessel revascularization (TVR) were 21.0% and 21.0% in OS groups versus 10.1 and 5.6% in the CO group (p = 0.20 and p = 0.04, respectively). Restenosis was higher in the OS than in CO group of patients and was located angiographically at the ostium. CONCLUSIONS: On long-term follow-up CO seems to be superior to OS technique for isolated ostial LAD disease especially in the presence of heavy calcification.
Authors: Francesco Burzotta; Jens Flensted Lassen; Thierry Lefèvre; Adrian P Banning; Yiannis S Chatzizisis; Thomas William Johnson; Miroslaw Ferenc; Sudhir Rathore; Remo Albiero; Manuel Pan; Olivier Darremont; David Hildick-Smith; Alaide Chieffo; Marco Zimarino; Yves Louvard; Goran Stankovic Journal: EuroIntervention Date: 2021-03-19 Impact factor: 6.534