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[Left main coronary artery stent application: early and late period results]
H Yilmaz1, O Sancaktar, I Demir
1Akdeniz Universitesi Tip Fakültesi, Kardiyoloji Anabilim Dali, Antalya. Dr.hy@um.turkcell.com.tr
Insights
Percutaneous coronary intervention (PCI) for left main coronary artery (LMCA) lesions is a viable alternative to surgery, especially for high-risk patients. This study shows PCI offers a safe option with acceptable outcomes for acute myocardial infarction and complex LMCA disease.
Area of Science:
- Interventional Cardiology
- Cardiovascular Medicine
- Medical Technology
Background:
- Left main coronary artery (LMCA) interventions are high-risk procedures.
- Coronary artery bypass surgery (CABG) carries increased mortality in certain patient groups.
- Percutaneous coronary intervention (PCI) is explored as a "last resort" for high-risk LMCA patients.
Purpose of the Study:
- To evaluate the short- and long-term outcomes of LMCA stenting.
- To assess PCI safety and efficacy in patients unsuitable for CABG.
- To analyze results in both protected and unprotected LMCA stenosis.
Main Methods:
- Retrospective analysis of 15 high-risk patients with LMCA stenosis undergoing stenting.
- Patients included those with acute myocardial infarction or high surgical risk.
- Use of intraaortic balloon pump and pacemaker documented.
Main Results:
- Overall mortality rate was 26.6% (4 out of 15 patients).
- Left ventricular failure occurred in 15.3% of survivors.
- Restenosis rate on follow-up angiography was 28.8%.
Conclusions:
- Elective stenting for high-risk LMCA lesions is a feasible alternative to surgery.
- PCI in acute myocardial infarction with LMCA involvement shows potential.
- Stenting provides a viable treatment option for complex LMCA disease.
Objectives:
Percutaneous coronary intervention of left main coronary artery (LMCA) in the setting of acute myocardial infarction or in patients with cardiac and non-cardiac diseases that increase mortality rate after coronary artery bypass surgery has been proposed as "last resort option" and these patients can be managed safely with intracoronary stenting. In this study, we evaluated the short- and long-term follow-up outcomes of patients with left main coronary lesions underwent stent implantation in our clinic.
Method:
A total of 15 patients (12 M, 3 F; mean age 58 +/- 13 years) with left main coronary stenosis considered at high risk for surgical treatment or patients with acute myocardial infarction with LMCA stenosis were enrolled into the study and treated by stenting. Eight patients were treated for unstable angina (53%), 2 had stable angina (13%) and 5 had acute myocardial infarction (33%). Three patients had "protected" and 12 patients "unprotected" LMCA stenosis. An intraaortic balloon pump was used in 6 (40%) and pacemaker in 4 (26.6%) patients.
Results:
In the study group the short and long-term mortality rate was 4 (26.6%). Among 13 survived cases, signs of left ventricular failure developed in 2 patients (15.3%). Restenosis rate on control coronary angiography was revealed in 28.8% of cases.
Conclusion:
Utilization of elective stenting in patients at high surgical risk with protected and unprotected LMCA lesions and percutaneous coronary intervention in patients with acute myocardial infarction and left main coronary artery lesions could be appraised as an alternative to surgical treatment approaches.