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Influence of vessel selection on the observed restenosis rate after endoluminal stenting or directional atherectomy
R E Kuntz1, T Hinohara, G C Robertson
1Charles A. Dana Research Institute, Boston, Massachusetts.
Insights
Vessel selection, not device type, significantly impacts restenosis rates after coronary interventions. Left anterior descending artery lesions show higher restenosis than right coronary arteries, regardless of stent or atherectomy use.
Area of Science:
- Cardiovascular Interventions
- Interventional Cardiology
- Medical Device Technology
Background:
- Restenosis rates vary among coronary interventions, potentially due to differences in treated vessels.
- Technical limitations of devices may influence vessel selection, confounding restenosis comparisons.
Purpose of the Study:
- To analyze the influence of vessel selection on restenosis rates after coronary stenting and directional atherectomy.
- To utilize "acute gain-late loss" analysis to assess the impact of vessel characteristics on restenosis.
Main Methods:
- Measured minimal luminal diameter before and after intervention in 102 stents and 347 atherectomies.
- Performed repeat angiographic measurements at 6 months for 82% of treated lesions.
- Compared restenosis rates based on device type (stent vs. atherectomy) and coronary location (LAD vs. RCA).
Main Results:
- Atherectomy-treated lesions predominantly involved the left anterior descending (LAD) artery (68%) compared to stents (31%).
- Overall restenosis rates were similar for stenting (25%) and atherectomy (30%).
- LAD lesions had significantly higher restenosis rates (35%) than right coronary artery (RCA) lesions (18%) across both intervention types.
- Multivariable analysis identified postprocedure luminal diameter and coronary location (LAD) as independent predictors of restenosis, not device type.
Conclusions:
- Coronary location, specifically the left anterior descending artery, is a significant determinant of restenosis.
- Postprocedure luminal diameter also independently predicts restenosis.
- Device type (stent vs. atherectomy) did not significantly influence restenosis rates in this study.
Abstract:
In comparing the restenosis rates among different interventions, 1 potential confounder might be the differences in the vessels treated, as dictated by the technical limitations of particular devices. The purpose of this study was to use current "acute gain-late loss" analysis to examine what influence vessel selection has on the restenosis rates seen after coronary stenting or directional atherectomy. The minimal luminal diameter of native coronary lesions was measured before and immediately after intervention in 102 single Palmaz-Schatz stents and 347 atherectomies, 367 (82%) of which had repeat angiographic measurement 6 months after intervention. Atherectomy-treated lesions had a higher proportion of left anterior descending to right coronary arteries (68 vs 24%) compared with stents (31 vs 54%), p < 0.001. Although subsequent restenosis rates were similar for stenting (25%) and atherectomy (30%, p = 0.42), left anterior descending versus right coronary lesions had a significantly higher restenosis rate for the overall group (35 vs 18%, p = 0.009), for stents (44 vs 13%, p = 0.008) and for atherectomy (35 vs 22%, p = 0.10), respectively. Multivariable analysis demonstrated that postprocedure luminal diameter (p = 0.03, p = 0.009) and coronary location (the proportion of left anterior descending vessels treated, p = 0.002, p < 0.001), but not device type (stent vs atherectomy), were strong independent determinants of restenosis according to both binary (> 50% diameter stenosis) and continuous (late percent stenosis) definitions.(ABSTRACT TRUNCATED AT 250 WORDS)