Long-Term Clinical Outcomes of Isolated Ostial Left Anterior Descending Disease Treatment: Ostial Stenting Versus Left Main Cross-Over Stenting |
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Authors: | Gianluca Rigatelli Marco Zuin Enrico Baracca Paola Galasso Mauro Carraro Alberto Mazza Daniela Lanza Loris Roncon Ramesh Daggubati |
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Affiliation: | 1. Cardiovascular Diagnosis and Endoluminal Interventions Unit, Rovigo General Hospital, Rovigo, Italy;2. Section of Internal and Cardiopulmonary Medicine, University of Ferrara, Ferrara, 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 |
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Abstract: | BackgroundThe 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.MethodsClinical 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).ResultsSeventy-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.ConclusionsOn long-term follow-up CO seems to be superior to OS technique for isolated ostial LAD disease especially in the presence of heavy calcification. |
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Keywords: | Corresponding author at: Cardiovascular Diagnosis and Endoluminal Interventions, Santa Maria della Misericordia Hospital, Viale Tre Martiri 140, 45100 Rovigo, Italy. Angioplasty Coronary angiography Surgery Interventional Coronary artery disease |
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