Long-term clinical outcome after directional coronary atherectomy followed by stem implantation

Background: Plaque debulking prior stent implantation reduces the restenosis rate and the restenosis-related events during the short-term clinical outcome. However, the long-term results are not fully characterized. Aims: To examine the long-term clinical outcome in a consecutive series of patients (pts) undergoing successful, elective, native-vessel directional coronary atherectomy (DCA) followed by stent implantation. Methods: Between May 1994 and December 2000, 298 pts with symptomatic coronary artery disease and/or objective evidence of myocardial ischemia (71% unstable angina) were treated by DCA followed by elective stenting. The pts were prospectively evaluated clinically [myocardial infarction (MI), death, target lesion revascularization (TLR)] after one month, six months and every six months and angiographically after six months or earlier in case of recurrence of symptoms/ischemia. Results: The combined approach of DCA followed by stent implantation was successfully performed in 272 out of 298 pts (primary success rate 91%)-283 lesions (87% LAD, 3% CX, 10% RCA). Sixty-nine pts (25%) had multivessel disease and 40 pts (15%) had diabetes. The immediate results were highly satisfactory (Minimal Luminal Diameter: 0.70+0.28 mm at baseline, 2.93+0.48 mm after DCA+stent; p 0.05) with very few periprocedural and in-hospital early major complications (2 deaths and 1 MI out of 272 pts; 1.1%). Angiographic follow-up was performed in 196 pts-205 lesions treated (72%) at 7±3 months (range 1-24 months) with a Loss Index of 0.37+0.32 and an angiographic (> 50%) restenosis rate of 14.7%. In a clinical follow-up of 23.5+13.8 months (range 1-80 months), non-fatal MI/death was observed in 4.2% and TLR at any time was needed in 15.4% of pts (Combined End-point: 17.4%). Conclusions: Plaque debulking by DCA followed by elective stenting is a relatively safe and effective procedure that ensures a good clinical long-term outcome.