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CLINICAL RESEARCH: INTERVENTIONAL CARDIOLOGY

Effectiveness of Sirolimus-Eluting Stent Implantation for the Treatment of Ostial Left Anterior Descending Artery Stenosis With Intravascular Ultrasound Guidance

Ki-Bae Seung, MD^_*, Young-Hak Kim, MD, Duk-Woo Park, MD, Bong-Ki Lee, MD, Cheol Whan Lee, MD, Myeong-Ki Hong, MD, Pum-Joon Kim, MD^_*, Wook-Sung Chung, MD^_*, Seung-Jea Tahk, MD, Seong-Wook Park, MD and Seung-Jung Park, MD^,_*

^_* Catholic University Hospital, Seoul, Korea
Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
Ajou University Hospital, Suwon, Korea

Manuscript received February 25, 2005; revised manuscript received April 1, 2005, accepted April 25, 2005.

^_* Reprint requests and correspondence: Dr. Seung-Jung Park, Department of Medicine, University of Ulsan College of Medicine, Asan Medical Center, 388-1 Poongnap-dong, Songpa-gu, Seoul 138-736, Korea (Email: sjpark{at}amc.seoul.kr).

OBJECTIVES: This study was designed to evaluate the clinical and angiographic outcomes of sirolimus-eluting stent (SES) implantation for ostial left anterior descending (LAD) lesions compared with bare-metal stent (BMS) implantation.

BACKGROUND: The effectiveness of SES implantation for ostial LAD lesions is currently unknown.

METHODS: Sirolimus-eluting stents were implanted in 68 consecutive patients with ostial LAD stenoses. The control group was composed of 77 patients treated with BMS during the preceding two years. In the SES group, for complete lesion coverage, stent positioning was intentionally extended into the distal left main coronary artery (LMCA) in 23 patients (34%) with intermediate LMCA narrowing.

RESULTS: Compared with the BMS group, the SES group had more multivessel involvement, received fewer debulking atherectomies, underwent more direct stenting, had a greater number of stents, and had more segments stented. The procedural success rate was 100% in both groups. The six-month angiographic restenosis rate was significantly lower in the SES group than in the BMS group (5.1% vs. 32.3%, p < 0.001). During the one-year follow-up period, neither death nor myocardial infarction occurred in either group, but target lesion revascularization was less frequent in the SES group than in the BMS group (0% vs. 17%, p < 0.001). In the SES group, there were no restenoses in cases with LMCA coverage, compared with three restenoses (7.9%) in cases with precise stent positioning (p = NS).

CONCLUSIONS: Sirolimus-eluting stent implantation in ostial LAD lesions achieved excellent results regarding restenosis and clinical outcomes compared with BMS implantation. This finding may be associated with reduced neointimal hyperplasia and complete lesion coverage.

Abbreviations and Acronyms   BMS = bare-metal stent   CSA = cross-sectional area   EEM = external elastic membrane   IVUS = intravascular ultrasound   LAD = left anterior descending coronary artery   LCX = left circumflex coronary artery   LMCA = left main coronary artery   MLD = minimal luminal diameter   SES = sirolimus-eluting stent

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