Favorable strategy for the ostial lesion of the left anterior descending coronary artery: Influence on narrowing of circumflex coronary artery

We examined the effectiveness of Palmaz-Schatz (P-S) stent and directional coronary atherectomy (DCA) in ostial lesions of left anterior descending arteries (LAD). The P-S stent was implanted in 11 cases at LAD ostial lesions, and DCA was performed in 13 cases. Percent stenosis and vessel diameter at the target site and the ostium of the circumflex coronary artery (LCX) were measured before and after the procedure. The initial success rate was 100% in both groups. No major complication occurred. LAD ostial lesions were improved from 81.3 ± 3.4% to −8.1 ± 5.7% by P-S stent and from 82.8 ± 2.6% to −2.7 ± 3.9% by DCA. LCX ostial vessel diameter was not changed by DCA (from 3.0 ± 0.2 mm to 3.1 ± 0.3 mm); however, it was significantly decreased by P-S stent (from 2.9 ± 0.2 mm to 2.6 ± 0.2 mm, P 80°. In cases with LAD-LCX angle ≦80°, however, DCA is a favored therapy rather than P-S stenting to avoid narrowing of the LCX ostium. Cathet. Cardiovasc. Diagn. 43:95–100, 1998. © 1998 Wiley-Liss, Inc.