Advantage of stents in the most proximal left anterior descending coronary artery

Balloon angioplasty of the proximal left anterior descending artery is associated with a high rate of restenosis. We hypothesized that the significant reduction in restenosis rates demonstrated by stent implantation in the coronary arteries in general would be especially prominent in the most proximal left anterior descending coronary artery.

We reviewed 65 consecutive patients in whom stents were placed in the most proximal left anterior descending artery between March 1990 and July 1995 and compared them with 56 consecutive patients with angioplasty. Minimum luminal diameter was measured angiographically before, after, and 6 months after the intervention. We compared the change in minimum luminal diameter and restenosis rate between the patients with stents and the patients with angioplasty to clarify the response of this important artery to these different procedures.

There was 6-month angiographic follow-up of the treated lesion in 99% of the patients. The postprocedure minimum luminal diameter, acute gain, and minimum luminal diameter at follow-up were greater in arteries treated with stents than in those treated with balloons. Of importance, late loss was not significantly different between the two groups after treatment at this site. Thus the restenosis rate after angioplasty was 52% compared with 20% after stent implantation (p < 0.001).

Stent implantation in the most proximal left anterior descending artery is associated with an even greater reduction in restenosis rate than implantations elsewhere in the coronary arteries. This enhanced reduction in restenosis appears to be due to an unusually large amount of late loss after angioplasty at this site.