From Lenox Hill Hospital, New York, NY (I.M., J.M.), and Centro Cuore
Columbus, Milan, Italy (C.D., G.B., B.R., Y.K., R.A., M.F., A.C.).
Correspondence to Antonio Colombo, MD, Centro Cuore Columbus, Via M Buonarrotti 48, 20145 Milan, Italy.
Background—Coronary
stenting has reduced restenosis in focal de novo lesions, but
its impact has been less pronounced in complex lesion subsets.
Preliminary data suggest a role for plaque burden in promoting intimal
hyperplasia after stent implantation. The aim of this study was to test
the hypothesis that plaque removal with directional atherectomy before
stent implantation may lower the intensity of late
neointimal hyperplasia, reducing the incidence of
in-stent restenosis.
Methods and Results—Seventy-one patients with 90 lesions
underwent directional atherectomy before coronary stenting.
Intravascular ultrasound–guided stenting was performed in 73 lesions
(81%). Clinical success was achieved in 96% of patients. Procedural
complications were as follows: emergency bypass surgery in 1 patient
(1.4%), who died 2 weeks later; Q-wave myocardial infarction in 2
patients (2.8%); and non–Q-wave myocardial infarction in 8 patients
(11.3%). None of the patients had stent thrombosis at follow-up.
Angiographic follow-up was performed in 89% of eligible patients at
5.7±1.7 months. Loss index was 0.33 (95% CI, 0.26 to 0.40),
and angiographic restenosis was 11% (95% CI, 5% to 20%).
Clinical follow-up was performed in all patients at 18±3 months.
Target lesion revascularization was 7% (95% CI,
3% to 14%).
Conclusions—Directional atherectomy followed by coronary
stenting could be performed with good clinical success rate. Also,
these data point to a possible reduction in angiographic
restenosis and a significant reduction in the need for repeated
coronary interventions. Therefore, a randomized clinical trial
seems appropriate to test the validity of this approach.
© 1998 American Heart Association, Inc.
Clinical Investigation and Reports
Stenting After Optimal Lesion Debulking (SOLD) Registry
Angiographic and Clinical Outcome
Key Words: stents • restenosis
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