Immediate and long-term results of treatment of complex lesions of the left anterior descending coronary artery involving a large diagonal branch with drug-eluting stents

Abstract

The treatment of complex long lesions of proximal left anterior descending artery involving the origin of diagonal branch is controversial. The aim of the present study is the evaluation of safety and clinical results of percutaneous coronary angioplasty with drug-eluting stents. Since June 2002, we instituted a prospective longitudinal registry of all consecutive patients according to inclusion criteria. Default strategy was drug-eluting stent implantation on left anterior descending coronary artery and provisional stenting of side branch. We enrolled 232 patients; only 35 were sent to surgery, 12 were treated with bare metal stents and eight with medical therapy. Provisional stenting was possible in 197 patients, whereas two stents were necessary in 35 patients. Final kissing balloon inflation was performed in 90% of patients. Overall, 30-day fatality linked with subacute stent thrombosis was 0.4%. Other in-hospital complications were 2.6% non-Q and 0.4% Q wave myocardial infarction. Global incidence of stent thrombosis was 1.7% (0.8% subacute, 0.4% late and 0.4% very late) with 50% fatality rate. Two patients died during follow-up; early and late mortality was 1.7%. Target lesion revascularization or target vessel revascularization was 7.3%, all managed by additional percutaneous intervention or medically. In our population of patients with complex 'off-label', bifurcated, long lesion of left anterior descending artery involving the main diagonal branch, the treatment by drug-eluting stents on left anterior descending artery and provisional stenting of the diagonal is possible in the absolute majority of patients with excellent long-term outcome.