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Long-Term Outcomes of Stent-Less Strategy Using Directional Coronary Atherectomy for the Ostial Left Circumflex
Hidenari Matsumura1, Kenichiro Shimoji1
1Department of Cardiology, Saiseikai Utsunomiya Hospital, Utsunomiya, Japan.
Insights
A stent-less approach using directional coronary atherectomy (DCA) and drug-eluting balloon (DEB) shows promising long-term results for left circumflex artery ostial lesions. This percutaneous coronary intervention (PCI) strategy offers a viable alternative to traditional stenting.
Area of Science:
- Interventional Cardiology
- Vascular Medicine
- Cardiovascular Interventions
Background:
- Long-term outcomes of percutaneous coronary intervention (PCI) for left circumflex artery (LCX) ostial lesions are suboptimal.
- Stent-less strategies using directional coronary atherectomy (DCA) and drug-eluting balloons (DEB) are being explored as alternatives.
- Limited data exists on the long-term efficacy of DCA and DEB for LCX ostial lesions.
Purpose of the Study:
- To evaluate the long-term outcomes of a stent-less PCI strategy.
- To assess the use of DCA followed by DEB for treating LCX ostial lesions.
- To compare this approach with conventional stent-based PCI strategies.
Main Methods:
- Retrospective analysis of patients treated with DCA and DEB for LCX ostial lesions (January 2019 - January 2024).
- DCA was used to reduce plaque area to <60%, followed by DEB angioplasty.
- Primary endpoint: clinically driven target lesion revascularization (TLR). Secondary endpoints: major adverse cardiac events (MACE) and bleeding complications.
Main Results:
- Ten patients were included; 50% had diabetes mellitus.
- 80% had concomitant left main trunk (LMT) to left anterior descending artery (LAD) lesions.
- One patient (10%) experienced TLR; no cardiac death, myocardial infarction (MI), or bleeding complications were observed. Median follow-up was 22 months.
Conclusions:
- Directional coronary atherectomy (DCA) followed by drug-eluting balloon (DEB) angioplasty demonstrates favorable long-term outcomes for LCX ostial lesions.
- This stent-less PCI approach offers a viable alternative to conventional stent-based strategies.
- Further research is warranted to confirm these findings in larger cohorts.
Background:
Long-term outcomes of percutaneous coronary intervention (PCI) for left circumflex artery (LCX) ostial lesions remain suboptimal. While a stent-less strategy using directional coronary atherectomy (DCA) and drug-eluting balloon (DEB) may offer a potential solution, no studies have reported on its long-term outcomes.
Aims:
This study aims to evaluate the long-term outcomes of a stent-less PCI strategy using DCA and DEB for LCX ostial lesions.
Methods:
We retrospectively analyzed consecutive patients treated for LCX ostial lesions with DCA to reduce plaque area to < 60%, followed by DEB angioplasty, at Saiseikai Utsunomiya Hospital, Tochigi, Japan, between January 2019 and January 2024. The primary endpoint was clinically driven target lesion revascularization. Secondary endpoints included major adverse cardiac events, defined as a composite of cardiac death, myocardial infarction (MI), and ischemia-driven target vessel revascularization, as well as bleeding complications.
Results:
Ten patients were included, five of whom had diabetes mellitus. A total of 80% had concomitant left main trunk (LMT) to left anterior descending artery (LAD) lesions; 60% underwent crossover stenting for LMT-LAD after LCX DCA, while two were treated with DCA and DEB for both LCX and LMT-LAD. All patients underwent follow-up using coronary computed tomography or angiography, with a follow-up period ranging from 8 to 56 months (median: 22 months, IQR: 21.7). TLR occurred in one patient (10%). No cases of cardiac death, MI, or bleeding complications were observed.
Conclusions:
DCA followed by DEB demonstrated favorable long-term outcomes for LCX ostial lesions, providing a viable alternative to conventional stent-based PCI strategies.
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