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CLINICAL STUDIES

Effect of plaque debulking and stenting on short- and long-term outcomes after revascularization of chronic total occlusions

^a Cardiovascular Research Foundation, New York, New York, USA
^b Cardiac Catheterization and Intravascular Ultrasound Imaging Laboratories, Washington Hospital Center, Washington, DC, USA. Dr. Gruberg is the recipient of the Physicians Fellowship for Medicine in Israel

Manuscript received February 2, 1999; revised manuscript received May 27, 1999, accepted September 14, 1999.

Reprint requests and correspondence: Dr. Mehran, Director, Clinical Research and Data Coordinating Center, Cardiovascular Research Foundation, 55 E. 59th Street, 6th floor, New York, New York 10022

OBJECTIVES

We evaluated the effect of plaque burden modification (debulking) on the short- and long-term clinical outcomes of patients with a totally occluded native coronary artery undergoing successful stent deployment.

BACKGROUND

Although the primary success rate of crossing a chronic totally occluded coronary artery has improved with the development of new interventional devices and guidewires, the rate of acute reocclusion and restenosis remains high.

METHODS

The in-hospital and late clinical outcomes of 150 patients who had undergone successful stenting of 176 chronic total occlusions were analyzed. After successful crossing of the lesion, 44 patients with 50 lesions underwent debulking by laser angioplasty, rotational or directional atherectomy followed by stenting, whereas 106 patients with 126 lesions underwent stent implantation without prior debulking.

RESULTS

Baseline clinical and angiographic characteristics were similar for the two groups, except for a higher incidence of left anterior descending coronary artery location and longer lesions in the group of patients who underwent debulking prior to stenting. In-hospital mortality, myocardial infarction and repeat angioplasty rates were similar for the two groups. At a mean 14 ± 8 months follow-up time, there were no deaths in either group, and target lesion revascularization rates were the same (16.3% in the debulking plus stent group vs. 14.4% in the stent alone group, p = NS).

CONCLUSIONS

Treatment of chronic total native coronary artery occlusions with stent deployment with and without lesion modification (debulking) results in a favorable in-hospital outcome, with relatively low long-term target lesion revascularization rates.

Abbreviations and Acronyms   CSA = cross-sectional area   DCA = directional coronary atherectomy   IVUS = intravascular ultrasound   LAD = left anterior descending artery   MI = myocardial infarction   MLD = minimal lumen diameter   PTCA = percutaneous transluminal coronary angioplasty   TIMI = Thrombolysis in Myocardial Infarction   TLR = target lesion revascularization

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