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Long-Term Observational Study of the Isolated Ostial Diagonal Stenosis in Patients with Chronic Coronary Syndrome
Akın Torun1, Burak Acar1, Göksel Kahraman1
1Kocaeli University Medical Faculty, Department of Cardiology, Kocaeli, Türkiye.
Insights
Isolated ostial diagonal stenosis is rare. Percutaneous coronary intervention was used for higher stenosis degrees, but medical management was linked to less angina, especially in wider arteries.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Isolated ostial diagonal stenosis is a rare condition.
- Percutaneous coronary intervention (PCI) for these lesions carries risks.
- Limited long-term data exists for managing this specific stenosis type.
Purpose of the Study:
- To characterize patients with isolated ostial diagonal stenosis.
- To evaluate long-term outcomes of PCI versus medical management.
- To assess the relationship between stenosis characteristics and angina presence.
Main Methods:
- Retrospective observational study (2014-2020).
- Analysis of 9769 coronary angiographies, identifying 87 with isolated diagonal stenosis.
- Evaluation of treatment modality and long-term angina severity.
Main Results:
- Median follow-up was 36 months.
- PCI was performed in 16.9% of patients, primarily for higher stenosis degrees.
- Patients undergoing PCI reported higher rates of angina (Class I), while those on medical treatment had more cases of no angina.
Conclusions:
- PCI is reserved for more severe diagonal artery stenosis.
- Medical management may be associated with better angina control, particularly in patients with wider diagonal arteries.
- Wider diagonal artery diameter correlates with increased angina regardless of treatment.
Objective:
Isolated ostial diagonal stenoses are very rare lesions in which percutaneous intervention could cause significant vessel compromise, and the long-term results have been reported in a few studies. This study sought the characteristics and long-term follow-up of the patients with isolated osteal diagonal stenosis regarding percutaneous coronary intervention and presence of angina.
Methods:
The study was an observational retrospective study conducted between January 2014 and December 2020. A total of 9769 patients who underwent coronary angiography were analyzed, and 87 patients had isolated diagonal stenosis. The patients were evaluated according to treatment modality and angina severity in long-term pattern.
Results:
Median follow-up time was 36 months. A total of 54 (83.1%) patients were followed up with only medical treatment, and 11 (16.9%) patients underwent revascularization in addition to medical treatment. The degree of stenosis of the diagonal artery was significantly higher in the percutaneous coronary intervention group than medical group (P = 0.002) and the patients with wider reference diameter of diagonal artery complaint of more angina (P = 0.007). Class I angina was significantly higher in percutaneous coronary intervention group than medical and the patients with no angina were significantly higher in medical group than percutaneous coronary intervention group.
Conclusion:
Percutaneous coronary intervention was mainly performed for diagonal arteries with a higher degree of stenosis; however, the patients who underwent percutaneous coronary intervention had angina more than 50% rates. Furthermore, the patients with ongoing angina had a larger diameter of the diagonal artery regardless of the type of treatment.
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