Stenting alone versus debulking and debulking plus stent in branch ostial lesions of native coronary arteries

Abstract

Angioplasty of branch ostial stenosis is associated with a high complication and restenosis rate. Previous investigations have demonstrated various treatments. However, the ideal strategy for treating branch ostial lesion remains uncertain. This investigation attempted to compare the acute, late results of stenting alone and debulking-based strategies in branch ostial lesions of native coronary arteries. Notably, various debulking strategies exist. This investigation also analyzed the acute and long-term results of the different treatments. In this study, we examined 86 patients with angina pectoris or exercise-induced ischemia and successful angioplasty of branch ostial lesions in native coronary arteries. The lesions were divided into two groups based on the angioplasty device used: group I (debulking devices, n = 44) and group II (stenting alone, n = 42). Procedural success and in-hospital complications were similar in both groups (P not significant). Following intervention, group I patients tended to show a smaller area of stenosis (42.3% ± 9.9% vs 48.2% ± 6.2%, P = 0.05) and a smaller plaque-media cross-sectional area (6.05 ± 1.87 vs 7.07 ± 1.79 mm², P = 0.01) than group II. Furthermore, at 3 months’ follow-up, group I exhibited a larger minimal lumen diameter (MLD) (2.30 ± 0.91 vs 1.86 ± 0.80 mm, P = 0.03) than group II. Regarding the angiographic and clinical outcomes, group I displayed a restenosis rate of 32% (14/44), compared with 41% (17/42) in group II (P = 0.40). Even during the 6-month follow-up, group I had a lower cumulative restenosis rate of 40% (17/43), compared with 60% (22/37) in group II (P = 0.04). The minimal luminal diameter of the ostium had not changed after directional coronary atherectomy or at follow-up. In contrast, MLD of another ostium was significantly reduced during stenting alone and at follow-up (P < 0.01). When subgroups were studied, a debulking followed by stent group achieved a larger acute lumen gain than a debulking alone group (2.57 ± 0.59 vs 2.32 ± 0.55 mm, P = 0.04). The optimal debulking plus stent subgroup had a restenosis rate of 9% (1/11) compared with 33% (6/18) in the optimal debulking alone group (P = 0.05). The optimal debulking plus stent group also had a lower cumulative restenosis rate at 6 months than the optimal debulking alone group (9% vs 44%, P = 0.04). Guided by intravascular ultrasound, atherectomy-based intervention appears superior to stenting alone for treating branch ostial lesions. Directional coronary atherectomy did not cause the narrowing of another ostium. However, optimal debulking followed by stenting minimized the restenosis and target lesion revascularization rates.