One-year results of paclitaxel-eluting stent implantation in ostial lesions of the left anterior descending artery

Background: Lesions in the ostial left anterior descending (LAD) coronary artery are usually considered an indication for bypass surgery because of possible distal left main (LM) involvement. Percutaneuos coronary intervention for such lesions is considered a high-risk procedure because of high rates of acute complications and later restenosis. The implantation of drug-eluting stents has been reported to reduce angiographic restenosis and major adverse cardiac events (MACE) compared to bare-metal stent. To date, there is little literature regarding the safety and efficacy of drug-eluting stent implantation in ostial LAD lesions. We sought to investigate the immediate and late clinical outcomes of paclitaxel-eluting stents (PES) implantation for such lesions. Methods: From July 2004 to October 2007, PES were implanted in 44 consecutive patients with ostial LAD stenoses in our hospital. We applied two different stenting strategies: (1) precise stent positioning, and (2) stent covering the distal LM coronary artery in the presence of intermediate distal LM lesions, thus ensuring full lesion coverage. We retrospectively reviewed the charts to assess MACE, which included cardiac death, non-fatal myocardial infarction (MI), target lesion revascularization (TLR) or target vessel revascularization. Results: Forty-four patients (30 males, 14 females) with a mean age of 64.4 ± 10.2 years (range, 46-83 years) were evaluated. The angiographic as well as procedural success rate was 100%, and none of the patients had in-hospital MACE. Clinical one-year follow-up was available for all patients. Angiographic follow-up was available for seventeen (38.6%) patients. Neither cardiac death nor stent thrombosis occurred in our patients, but one (2.3%) patient had non-fatal MI during the follow-up period. Four patients had clinically-driven angiographic restenosis and underwent TLR subsequently. The cumulative MACE-free survival rate was 88.6% at one year. Conclusions: Paclitaxel-eluting stent implantation in ostial LAD lesions with complete lesion coverage achieves high procedural success rate and acceptable clinical outcomes during the one-year follow-up period.