Medical treatment versus angioplasty for isolated ostial diagonal stenoses: a comparative clinical follow-up.

Angioplasty of a stenosis at the ostium of a diagonal branch of the left anterior descending artery as an isolated lesion often poses a dilemma due to the risk involved in treating the lesion in comparison to the potential benefit. Therefore, we sought to investigate our experience with this issue. Between 1995 and 2010, we retrospectively analyzed 39,300 patients who underwent invasive coronary angiography in our institution. Of these, a total of 22 had an isolated diagonal stenosis. The patients were either treated conservatively or underwent angioplasty and were followed for several years. Clinical and angiographic data were compared between the two groups. Thirteen of the patients were treated conservatively and 9 underwent successful PCI. Baseline characteristics did not differ between the groups. The severity of the stenosis was also similar in the two groups, but in the angioplasty group, the diameter of the vessel was significantly larger (P<.01). More patients were recatheterized during the follow-up period in the conservative arm, although this did not reach statistical difference. There was no difference in mortality between the two groups. Initial conservative medical approach is a reasonable approach in treating isolated diagonal ostial stenosis.