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CLINICAL RESEARCH: INTERVENTIONAL CARDIOLOGY

Pre–Drug-Eluting Stent Debulking of Bifurcated Coronary Lesions

Etsuo Tsuchikane, MD, PhD^_*,_*, Tadanori Aizawa, MD, Hideo Tamai, MD, Yasumi Igarashi, MD, Kenji Kawajiri, MD^||, Noriyuki Ozawa, MD^¶, Shigeru Nakamura, MD^#, Koji Oku, MD^_**, Mikihiro Kijima, MD, Takahiko Suzuki, MD^_* for the PERFECT Investigators

^_* Department of Cardiology, Toyohashi Heart Center, Aichi, Japan
Department of Cardiology, The Cardiovascular Institute Hospital, Tokyo, Japan
Department of Cardiology, Kusatsu Heart Center, Kusatsu, Japan
Department of Cardiology, Sapporo City General Hospital, Sapporo, Japan
^|| Department of Cardiology, Matsubara Tokushukai Hospital, Osaka, Japan
^¶ Department of Cardiology, Yokohama Asahi General Hospital, Kanagawa, Japan
^# Department of Cardiology, Kyoto Katsura Hospital, Kyoto, Japan
^_** Department of Cardiology, Nagasaki Medical Center, Nagasaki, Japan
Department of Medicine, Hoshi General Hospital, Fukushima, Japan.

Manuscript received April 24, 2007; revised manuscript received July 16, 2007, accepted July 23, 2007.

^_* Reprint requests and correspondence: Dr. Etsuo Tsuchikane, Toyohashi Heart Center, 21-1, Gobudori, Ohyama, Toyohashi, Aichi 441-8530, Japan. (Email: dokincha{at}aioros.ocn.ne.jp).

Objectives: The purpose of this study was to evaluate the efficacy of plaque debulking by directional coronary atherectomy (DCA) before drug-eluting stent (DES) implantation for bifurcated coronary lesions.

Background: The introduction of DES significantly reduces restenosis and repeated revascularization. However, percutaneous coronary intervention of bifurcated lesions using DES alone remains challenging regardless of whether simple or complex stenting is used.

Methods: Patients with bifurcated lesions were recruited in this prospective multicenter registry. Pre-DES plaque debulking by DCA was conducted. All patients were scheduled to undergo a 9-month coronary angiography. The primary end point was the 9-month binary angiographic restenosis rate. Secondary end points included procedure-related events and major adverse cardiac events (MACE) at 1 year.

Results: A total of 99 patients with bifurcated lesions were enrolled in this registry. Directional coronary atherectomy was performed successfully in all cases without any major procedure-related events. Simple stenting was achieved in all but 2 cases. No in-hospital MACE were observed. The 9-month binary restenosis rates in the main branch and side branch were 1.1% and 3.4%, respectively. Target lesion revascularization was performed in 2 patients (1 for the main branch and the other for the side branch). No deaths, no coronary artery bypass grafting, and no myocardial infarctions were reported in the patients within the first year.

Conclusions: Directional coronary atherectomy before DES implantation can possibly avoid complex stenting. This strategy may provide a good long-term outcome in patients with bifurcated lesions.

Abbreviations and Acronyms   CK = creatine kinase   DCA = directional coronary atherectomy   DES = drug-eluting stent(s)   IVUS = intravascular ultrasound   KBT = kissing balloon technique   MACE = major adverse cardiac events   PA = plaque plus the media cross-sectional area   PCI = percutaneous coronary intervention   QMI = Q-wave myocardial infarction   TLR = target lesion revascularization

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